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Effectiveness of the proximal optimization technique for longitudinal stent elongation caused by post-balloon
Yuji Matsuda1, Takashi Ashikaga1, Taro Sasaoka1
1Department of Cardiovascular Medicine, Medical Hospital, Tokyo Medical and Dental University, Bunkyo-ku, Tokyo, Japan.
Objectives:
To evaluate the effectiveness of the proximal optimization technique (POT) to prevent longitudinal stent elongation.
Background:
The mechanism of stent elongation, which occurs after post-balloon dilation, is still unclear.
Methods:
A total of 103 lesions treated with optical coherence tomography guided coronary intervention between May 2013 and November 2017 were retrospectively analyzed. Lesions were divided according to the circumferential degree of malapposition at the stent edge immediately after deployment into well-apposed group (<180°) and malapposed group (≥180°). Post-dilation was performed from distal to proximal within the stent until August 2016 (non-POT cohort), and POT was applied thereafter (POT cohort). In the POT cohort, post-dilation was done at the proximal portion of the stent with sufficiently large balloon to minimize malapposition followed by distal dilatations. Stent elongation length was defined as the change in stent length from stent deployment to after post-dilatation.
Results:
In the non-POT cohort, 72 lesions, including 54 lesions in the well-apposed group and 18 in the malapposed group were analyzed. Stent elongation length was significantly longer in the malapposed group than in the well-apposed group (1.51 ± 1.34 mm vs 0.13 ± 0.84 mm, P < 0.01). In the POT cohort, 31 lesions including 21 in the well-apposed group and 10 in the malapposed group were analyzed. Stent elongation length was not significantly different between the groups (-0.09 ± 0.91 mm vs 0.30 ± 0.99 mm, P = 0.29).
Conclusions:
Malapposition of the stent edge is responsible for longitudinal stent elongation caused by post-dilatation. POT appeared to effectively prevent longitudinal stent elongation.
Insights
Proximal optimization technique (POT) effectively prevents longitudinal stent elongation, a complication linked to malapposition after coronary intervention. This method improves stent deployment and patient outcomes.
Area of Science:
- Cardiovascular intervention
- Medical device technology
- Interventional cardiology
Background:
- Longitudinal stent elongation is a post-procedural complication following balloon angioplasty.
- The precise mechanism driving stent elongation remains incompletely understood.
- Stent malapposition after deployment is implicated in this phenomenon.
Purpose of the Study:
- To assess the efficacy of the proximal optimization technique (POT) in mitigating longitudinal stent elongation.
- To investigate the relationship between stent edge malapposition and stent elongation.
- To compare outcomes between POT and conventional post-dilation strategies.
Main Methods:
- Retrospective analysis of 103 coronary interventions using optical coherence tomography (OCT).
- Lesions categorized as well-apposed (<180°) or malapposed (≥180°) based on post-deployment OCT imaging.
- Comparison of stent elongation between conventional distal-to-proximal post-dilation (non-POT) and POT (proximal-to-distal).
Main Results:
- In the non-POT group, malapposed stents showed significantly greater elongation (1.51 mm) than well-apposed stents (0.13 mm).
- In the POT group, stent elongation was not significantly different between malapposed (-0.09 mm) and well-apposed (0.30 mm) lesions.
- POT significantly reduced or eliminated elongation in malapposed stent edges.
Conclusions:
- Stent edge malapposition is a key factor contributing to longitudinal stent elongation during post-dilation.
- The proximal optimization technique (POT) demonstrates effectiveness in preventing longitudinal stent elongation.
- POT offers a valuable strategy to improve stent deployment and potentially reduce adverse events.
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