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Updated: Dec 28, 2025
Imaging In-Stent Restenosis: An Inexpensive, Reliable, and Rapid Preclinical Model
Published on: September 14, 2009
Post-dilatation improves stent apposition in patients with ST-segment elevation myocardial infarction receiving
Jun Jiang1, Nai-Liang Tian2, Han-Bin Cui3
1Department of Cardiology, the Second Affiliated Hospital of Zhejiang University School of Medicine, Hangzhou, China.
Insights
Post-dilatation after stenting in ST-segment elevation myocardial infarction (STEMI) improves stent apposition. This technique enhanced incomplete strut apposition rates at 7 months without impacting major adverse cardiovascular events.
Area of Science:
- Cardiovascular Medicine
- Interventional Cardiology
- Biomedical Engineering
Background:
- Stent failure risks are elevated in lipid-rich, thrombus-laden lesions common in ST-segment elevation myocardial infarction (STEMI).
- Optimizing stent deployment is crucial for improving outcomes in acute myocardial infarction.
Purpose of the Study:
- To evaluate the effectiveness of post-dilatation following primary percutaneous coronary intervention (pPCI) in STEMI patients.
- To assess the impact of post-dilatation on stent apposition and coverage.
Main Methods:
- The multi-center POST-STEMI trial randomized 41 STEMI patients to either a control group or a post-dilatation group.
- Optical coherence tomography (OCT) evaluated strut apposition and coverage post-pPCI and at 7-month follow-up.
- The primary endpoint was incomplete strut apposition (ISA) at 7 months.
Main Results:
- Post-dilatation significantly reduced ISA rates immediately after pPCI (2.5% vs. 4.5%) and at 7 months (0.7% vs. 1.8%).
- Coronary blood flow, assessed by TIMI flow and corrected TIMI frame counts, remained unaffected.
- Stent coverage and 1-year major adverse cardiovascular events (MACE) rates were similar between groups.
Conclusions:
- Post-dilatation following stent implantation in STEMI patients improves strut apposition up to 7 months.
- This adjunctive technique does not compromise coronary blood flow or increase MACE.
- Larger studies are recommended to further confirm safety and efficacy.
Background:
Stent failure is more likely in the lipid rich and thrombus laden culprit lesions underlying ST-segment elevation myocardial infarction (STEMI). This study assessed the effectiveness of post-dilatation in primary percutaneous coronary intervention (pPCI) for acute STEMI.
Methods:
The multi-center POST-STEMI trial enrolled 41 consecutive STEMI patients with symptom onset <12 hours undergoing manual thrombus aspiration and Promus Element stent implantation. Patients were randomly assigned to control group (n=20) or post-dilatation group (n=21) in which a non-compliant balloon was inflated to >16 atm pressure. Strut apposition and coverage were evaluated by optical coherence tomography (OCT) after intracoronary verapamil administration via thrombus aspiration catheter, post pPCI and at 7-month follow-up. The primary endpoint was rate of incomplete strut apposition (ISA) at 7 months after pPCI.
Results:
There were similar baseline characteristics except for stent length (21.9 [SD 6.5] mm vs. 26.0 [SD 5.8] mm, respectively, P=0.03). In post-dilatation vs. control group, ISA rate was lower (2.5% vs. 4.5%, P=0.04) immediately after pPCI without affecting final TIMI flow 3 rate (95.2% vs. 95.0%, P>0.05) or corrected TIMI frame counts (22.6±9.4 vs. 22.0±9.7, P>0.05); and at 7-month follow-up (0.7% vs. 1.8%, P<0.0001), the primary study endpoint, with similar strut coverage (98.5% vs. 98.4%, P=0.63) and 1-year rate of major adverse cardiovascular events (MACE).
Conclusion:
In STEMI patients, post-dilatation after stent implantation and thrombus aspiration improved strut apposition up to 7 months without affecting coronary blood flow or 1-year MACE rate. Larger and longer term studies are warranted to further assess safety (ClinicalTrials.gov identifier: NCT02121223).
