[Management of stent under-expansion]

Area of Science:

• Cardiovascular Interventions
• Medical Device Technology
• Interventional Cardiology

Background:

• Stent under-expansion is a significant predictor of adverse cardiovascular events, including in-stent restenosis and stent thrombosis.
• Excessive calcification at the target lesion site is a primary cause of stent under-expansion.
• Effective treatment strategies are crucial to address calcified lesions and ensure optimal stent deployment.

Purpose of the Study:

• To review and compare available devices for treating stent under-expansion caused by calcified lesions.
• To evaluate the mechanisms and clinical potential of different therapeutic modalities.

Main Methods:

• Discussion of super high-pressure non-compliant (NC) balloons, highlighting their ability to overcome calcific resistance.
• Description of excimer laser technology for fragmenting calcified plaque around stents, noting its effectiveness and required operator expertise.
• Overview of intravascular lithotripsy (IVL) as a novel approach using sonic waves to fracture calcifications and increase vessel compliance.

Main Results:

• NC OPNTM balloons can achieve high pressures (up to 35 atm) to facilitate stent expansion in calcified lesions.
• Excimer laser ablation effectively fragments atherosclerotic material but necessitates specialized skills to mitigate complications.
• Intravascular lithotripsy demonstrates promising results in selectively targeting and fracturing calcific components, enhancing vessel compliance.

Conclusions:

• Multiple device-based strategies exist to manage stent under-expansion due to calcified lesions.
• Each technology presents unique advantages and challenges, influencing their clinical application and patient outcomes.
• Intravascular lithotripsy emerges as a recent and promising method for treating complex calcified lesions, improving vessel preparation for stenting.