Unrecoverable stent deformation in the left main: Crush it or remove it?

Area of Science:

• Interventional Cardiology
• Cardiovascular Devices
• Biomedical Engineering

Background:

• Left main coronary artery lesions pose significant challenges for interventional cardiologists.
• Potential complications include stent deformation and procedural failure.

Purpose of the Study:

• To discuss left main stent deformation during percutaneous coronary intervention (PCI).
• To debate the risks and benefits of immediate stent explantation.
• To in-vitro test the theory of "insufficient" crush with high-radial-strength stents compared to conventional ones.

Main Methods:

• Case presentation of a high-risk PCI requiring immediate stent explantation.
• In-vitro bench testing comparing high-radial-strength stents with conventional stents under simulated "crush" conditions.
• Evaluation of stent deformation, underexpansion, recoil, and malapposition.

Main Results:

• Immediate stent explantation was necessary due to the risk of unacceptable procedural outcomes from stent deformation.
• Bench testing demonstrated significant stent underexpansion, recoil, and malapposition with high-radial-strength stents.
• Inadequate minimal stent area was observed in bench tests simulating "insufficient" crush.

Conclusions:

• Ad-hoc stent explantation can be a necessary strategy in complex left main PCI with high-strength stents.
• High-radial-strength stent platforms may be prone to deformation and underexpansion, impacting procedural success.
• Further in-vitro and clinical studies are warranted to optimize PCI strategies for left main lesions.