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Monitoring the Wall Mechanics During Stent Deployment in a Vessel
Published on: May 8, 2012
Influence of a pressure gradient distal to implanted bare-metal stent on in-stent restenosis after percutaneous
Lisette Okkels Jensen1, Per Thayssen, Leif Thuesen
1Department of Cardiology, Catheterization Laboratory, Odense University Hospital, Sdr Blvd 29, 5000 Odense C, Denmark. okkels@dadlnet.dk
Insights
A persistent pressure gradient distal to a coronary stent, indicating abnormal fractional flow reserve, predicts higher rates of in-stent restenosis after bare-metal stent implantation.
Area of Science:
- Cardiovascular Medicine
- Interventional Cardiology
- Medical Imaging
Background:
- Fractional flow reserve (FFR) is crucial for predicting cardiac events post-coronary stent implantation.
- Assessing in-stent restenosis (ISR) rates is vital for evaluating stent performance.
- Optimal stenting techniques aim to minimize adverse outcomes.
Purpose of the Study:
- To evaluate the 9-month angiographic in-stent restenosis rate.
- To investigate the impact of a persisting pressure gradient distal to the stent, measured by pressure wire pullback, on ISR.
- To determine predictors of ISR in patients undergoing bare-metal stenting.
Main Methods:
- Ninety-eight patients with angina pectoris received a bare-metal stent for a de novo coronary lesion.
- Pressure wire measurements, including distal pressure (P(d)) and aortic pressure (P(a)), were taken at multiple points.
- A residual abnormal P(d)/P(a) was defined as a pressure drop between the distal artery and just distal to the stent.
Main Results:
- Patients with a residual abnormal P(d)/P(a) showed significantly lower fractional flow reserve (0.88 vs. 0.97) and higher in-stent restenosis rates (44.0% vs. 8.1%).
- Residual abnormal P(d)/P(a) (OR, 4.39), reference vessel size (OR, 0.17), and stent length (OR, 1.11) were identified as independent predictors of ISR.
- These findings highlight the significance of pressure gradients in predicting restenosis.
Conclusions:
- A residual abnormal pressure gradient distal to a bare-metal stent is an independent predictor of in-stent restenosis.
- This pressure measurement provides valuable prognostic information after coronary stenting.
- Optimizing stenting to eliminate distal pressure gradients may reduce restenosis rates.
Background:
Fractional flow reserve predicts cardiac events after coronary stent implantation. The aim of the present study was to assess the 9-month angiographic in-stent restenosis rate in the setting of optimal stenting and a persisting gradient distal to the stent as assessed by a pressure wire pullback recording in the entire length of the artery.
Methods And Results:
In 98 patients with angina pectoris, 1 de novo coronary lesion was treated with a bare-metal stent. After stent implantation, pressure wire measurements (P(d)=mean hyperemic coronary pressure and P(a)=mean aortic pressure) were performed in the target vessel: (1) P(d)/P(a) as distal to the artery as possible (fractional flow reserve per definition); (2) P(d)/P(a) just distal to the stent; (3) P(d)/P(a) just proximal to the stent; and (4) P(d)/P(a) at the ostium. Residual abnormal P(d)/P(a) was defined as a pressure drop between P(d)/P(a) measured at points 1 and 2. Fractional flow reserve distal to the artery after stenting was significantly lower (0.88+/-0.21 versus 0.97+/-0.05; P<0.001), and angiographic in-stent binary restenosis rate was significantly higher (44.0% versus 8.1%; P<0.001) in vessels with a residual abnormal P(d)/P(a). Residual abnormal P(d)/P(a) (odds ratio, 4.39; 95% confidence interval, 1.10 to 18.16; P=0.034), reference vessel size (odds ratio, 0.17; 95% confidence interval, 0.04 to 0.69; P=0.013), and stent length (odds ratio, 1.11; 95% confidence interval, 1.03 to 1.21; P=0.009) were predictors of angiographic in-stent restenosis after 9 months.
Conclusions:
A residual abnormal P(d)/P(a) distal to a bare-metal stent was an independent predictor of in-stent restenosis after implantation of a coronary bare-metal stent.
