Cardiovascular Revascularization Medicine xxx (2015) xxx–xxx
Contents lists available at ScienceDirect
Cardiovascular Revascularization Medicine
Stent deformation at the edge of a high pressure balloon☆ Ismail Dogu Kilic a, Nicolas Foin b, Nikolaos Konstantinidis a, Roberta Serdoz a, Gianluca Caiazzo a, Carlo Di Mario a,⁎ a b
The NIHR Cardiovascular BRU, Royal Brompton Hospital & NHLI Imperial College, London, UK National Heart Centre, Singapore
a r t i c l e
i n f o
Article history: Received 19 January 2015 Received in revised form 2 March 2015 Accepted 6 March 2015 Available online xxxx
a b s t r a c t Focal ultrashort balloons are essential tools for lesion preparation and final stent expansion. However, they may cause a major distortion of the adjacent segments. Here we report a case with a stent deformation emphasizing the importance of utilizing intravascular imaging techniques for optimal interventions. © 2015 Elsevier Inc. All rights reserved.
Keywords: Optical coherence tomography Stent Deformation
A 53-year-old man with hypertension, smoking and diabetes developed exertional chest pain and underwent coronary angiography showing significant stenoses in the proximal and mid-LAD that were found alongside extensive calcification in the LAD. A 2.0 mm balloon did not expand forcing us to use a rotational atherectomy. After Rotablator, a 2.5 mm non-compliant balloon easily expanded, followed by a 2.75 × 32 mm Promus Premier Stent (Boston Scientific, MA, USA) and by post-dilatation with a 3.5 mm non-compliant balloon. The proximal lesion was covered with a 3.5 × 32 mm Promus Premier, overlapping with the first stent. After postdilatation, OCT showed good stent expansion and apposition in the distal stent and the overlap segment, but a focal lesion in the first 2 cm of the proximal stent required postdilatation with a 4.0 mm × 8 mm balloon (28 atm), starting a few millimetres proximal to the overlap. Postdilatation succeeded in apposing and expanding the proximal segment of the stent, but the distal segment had a localized distortion with severe malapposition, corrected with further dilatation (Fig. 1). To study the possible impact of post-dilatation on stent geometry, we deployed a 3.0 mm Promus Element stent in an in-vitro silicon phantom model at nominal pressure. We subsequently used a larger
3.5 × 10 m NC balloon at 14 atm to post-dilate the proximal segment of the stent. The final result was then analyzed using micro computed tomography (X-tek systems, UK). Distal to the post-dilated area, we noted a mild indentation of the stent, however not as markedly observed in-vivo (Fig. 2). Focal ultrashort (6–8 mm) balloons are an essential tool for lesion preparation and final stent expansion. Unfortunately they may cause a major distortion of the adjacent segments. This case also emphasizes the importance of utilizing intravascular imaging techniques for optimal interventions, especially in ostial–proximal lesions. Acknowledgement Ismail Dogu Kilic was supported by a research grant from the “The Scientific and Technological Research Council of Turkey (TUBITAK). Appendix A. Supplementary data Supplementary data to this article can be found online at http://dx. doi.org/10.1016/j.carrev.2015.03.001.
☆ Authors' conflict of interest in relation to the present manuscript: Nothing to disclose. ⁎ Corresponding author at: NIHR Cardiovascular BRU, Royal Brompton Hospital, Sydney Street, London SW3 6NP. Tel.: +44 2073518616; fax: +44 2073518104. E-mail address: [email protected] (C. Di Mario). http://dx.doi.org/10.1016/j.carrev.2015.03.001 1553-8389/© 2015 Elsevier Inc. All rights reserved.
Please cite this article as: Kilic ID, et al, Stent deformation at the edge of a high pressure balloon, Cardiovasc Revasc Med (2015), http://dx.doi.org/ 10.1016/j.carrev.2015.03.001
2
I.D. Kilic et al. / Cardiovascular Revascularization Medicine xxx (2015) xxx–xxx
Fig. 1. A – OCT showed stent distortion on the overlapping area (as newly malapposed struts after postdilatation); B – Stent deformation was focal as seen from the good apposition in the adjacent segments.
Fig. 2. A 3.0 mm Promus Element stent was deployed in an in-vitro silicon phantom model at nominal pressure, which is subsequently post-dilated using a larger 3.5 × 10 m NC balloon at 14 atm in the proximal segment. Microcomputed tomography showed a mild indentation of the stent distal to the post-dilated area (arrow).
Please cite this article as: Kilic ID, et al, Stent deformation at the edge of a high pressure balloon, Cardiovasc Revasc Med (2015), http://dx.doi.org/ 10.1016/j.carrev.2015.03.001
Contents lists available at ScienceDirect
Cardiovascular Revascularization Medicine
Stent deformation at the edge of a high pressure balloon☆ Ismail Dogu Kilic a, Nicolas Foin b, Nikolaos Konstantinidis a, Roberta Serdoz a, Gianluca Caiazzo a, Carlo Di Mario a,⁎ a b
The NIHR Cardiovascular BRU, Royal Brompton Hospital & NHLI Imperial College, London, UK National Heart Centre, Singapore
a r t i c l e
i n f o
Article history: Received 19 January 2015 Received in revised form 2 March 2015 Accepted 6 March 2015 Available online xxxx
a b s t r a c t Focal ultrashort balloons are essential tools for lesion preparation and final stent expansion. However, they may cause a major distortion of the adjacent segments. Here we report a case with a stent deformation emphasizing the importance of utilizing intravascular imaging techniques for optimal interventions. © 2015 Elsevier Inc. All rights reserved.
Keywords: Optical coherence tomography Stent Deformation
A 53-year-old man with hypertension, smoking and diabetes developed exertional chest pain and underwent coronary angiography showing significant stenoses in the proximal and mid-LAD that were found alongside extensive calcification in the LAD. A 2.0 mm balloon did not expand forcing us to use a rotational atherectomy. After Rotablator, a 2.5 mm non-compliant balloon easily expanded, followed by a 2.75 × 32 mm Promus Premier Stent (Boston Scientific, MA, USA) and by post-dilatation with a 3.5 mm non-compliant balloon. The proximal lesion was covered with a 3.5 × 32 mm Promus Premier, overlapping with the first stent. After postdilatation, OCT showed good stent expansion and apposition in the distal stent and the overlap segment, but a focal lesion in the first 2 cm of the proximal stent required postdilatation with a 4.0 mm × 8 mm balloon (28 atm), starting a few millimetres proximal to the overlap. Postdilatation succeeded in apposing and expanding the proximal segment of the stent, but the distal segment had a localized distortion with severe malapposition, corrected with further dilatation (Fig. 1). To study the possible impact of post-dilatation on stent geometry, we deployed a 3.0 mm Promus Element stent in an in-vitro silicon phantom model at nominal pressure. We subsequently used a larger
3.5 × 10 m NC balloon at 14 atm to post-dilate the proximal segment of the stent. The final result was then analyzed using micro computed tomography (X-tek systems, UK). Distal to the post-dilated area, we noted a mild indentation of the stent, however not as markedly observed in-vivo (Fig. 2). Focal ultrashort (6–8 mm) balloons are an essential tool for lesion preparation and final stent expansion. Unfortunately they may cause a major distortion of the adjacent segments. This case also emphasizes the importance of utilizing intravascular imaging techniques for optimal interventions, especially in ostial–proximal lesions. Acknowledgement Ismail Dogu Kilic was supported by a research grant from the “The Scientific and Technological Research Council of Turkey (TUBITAK). Appendix A. Supplementary data Supplementary data to this article can be found online at http://dx. doi.org/10.1016/j.carrev.2015.03.001.
☆ Authors' conflict of interest in relation to the present manuscript: Nothing to disclose. ⁎ Corresponding author at: NIHR Cardiovascular BRU, Royal Brompton Hospital, Sydney Street, London SW3 6NP. Tel.: +44 2073518616; fax: +44 2073518104. E-mail address: [email protected] (C. Di Mario). http://dx.doi.org/10.1016/j.carrev.2015.03.001 1553-8389/© 2015 Elsevier Inc. All rights reserved.
Please cite this article as: Kilic ID, et al, Stent deformation at the edge of a high pressure balloon, Cardiovasc Revasc Med (2015), http://dx.doi.org/ 10.1016/j.carrev.2015.03.001
2
I.D. Kilic et al. / Cardiovascular Revascularization Medicine xxx (2015) xxx–xxx
Fig. 1. A – OCT showed stent distortion on the overlapping area (as newly malapposed struts after postdilatation); B – Stent deformation was focal as seen from the good apposition in the adjacent segments.
Fig. 2. A 3.0 mm Promus Element stent was deployed in an in-vitro silicon phantom model at nominal pressure, which is subsequently post-dilated using a larger 3.5 × 10 m NC balloon at 14 atm in the proximal segment. Microcomputed tomography showed a mild indentation of the stent distal to the post-dilated area (arrow).
Please cite this article as: Kilic ID, et al, Stent deformation at the edge of a high pressure balloon, Cardiovasc Revasc Med (2015), http://dx.doi.org/ 10.1016/j.carrev.2015.03.001
