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Thrombus burden management during primary coronary bifurcation intervention: a new experimental bench model
Ahmad Hayek1, Yassim Dargaud2, Luc Maillard3
1Department of Interventional Cardiology, Cardiovascular Hospital and Claude Bernard University and INSERM Unit 1060 CARMEN, Lyon, France.
Insights
This study developed a new bench model to assess thrombus burden during coronary bifurcation stenting. Nitinol self-apposing stents (SAS) and balloon-expandable stents with proximal optimizing technique (POT) improved stent apposition compared to standard balloon-expandable stents.
Area of Science:
- Cardiovascular Interventions
- Biomedical Engineering
- Thrombosis Research
Background:
- Managing thrombus burden during primary percutaneous coronary intervention (pPCI) is critical, especially in coronary bifurcations, due to risks of stent malapposition and embolization.
- A novel experimental bifurcation bench model was created to analyze thrombus behavior during pPCI procedures.
Purpose of the Study:
- To evaluate and compare thrombus burden, stent apposition, and embolization across different provisional pPCI strategies in a coronary bifurcation model.
- To quantify the effectiveness of balloon-expandable stents (BES), BES with proximal optimizing technique (POT), and nitinol self-apposing stents (SAS) in managing thrombus.
Main Methods:
- A fractal left main bifurcation bench model was used, with standardized thrombus generated from human blood and tissue factor.
- Three provisional pPCI strategies were tested: isolated BES, BES + POT, and SAS (n=10 per group).
- Quantification of embolized thrombus, trapped thrombus, and stent apposition using 2D-Optical Coherence Tomography (OCT) before and after thrombolysis.
Main Results:
- Balloon-expandable stents (BES) trapped significantly more thrombus (18.8%) compared to SAS (10.3%) and BES+POT (6.2%).
- SAS and BES+POT demonstrated superior final stent global apposition (0.4% and 1.3%, respectively) compared to isolated BES (74.0%).
- No significant difference was observed in embolized thrombus between the strategies.
Conclusions:
- The developed bench model effectively quantifies thrombus trapping and embolization during pPCI in bifurcations.
- While BES showed higher thrombus trapping, SAS and BES+POT provided significantly better final stent apposition.
- Stent selection for bifurcation pPCI should consider both thrombus trapping and final stent apposition.
Background:
Management of thrombus burden during primary percutaneous coronary intervention (pPCI) is a key-point, given the high risk of stent malapposition and/or thrombus embolization. These issues are especially important if pPCI involves a coronary bifurcation. Herein, a new experimental bifurcation bench model to analyze thrombus burden behavior was developed.
Methods:
On a fractal left main bifurcation bench model, we generated standardized thrombus with human blood and tissue factor. Three provisional pPCI strategies were compared (n = 10/group): 1) balloon-expandable stent (BES), 2) BES completed by proximal optimizing technique (POT), and 3) nitinol self-apposing stent (SAS). The embolized distal thrombus after stent implantation was weighed. Stent apposition and thrombus trapped by the stent were quantified on 2D-OCT. To analyze final stent apposition, a new OCT acquisition was performed after pharmacological thrombolysis.
Results:
Trapped thrombus was significantly greater with isolated BES than SAS or BES+POT (18.8 ± 5.8% vs. 10.3 ± 3.3% and 6.2 ± 2.1%, respectively; p < 0.05), and greater with SAS than BES+POT (p < 0.05). Isolated BES and SAS tended show less embolized thrombus than BES+POT (5.93 ± 4.32 mg and 5.05 ± 4.56 mg vs. 7.01 ± 4.32 mg, respectively; p = NS). Conversely, SAS and BES+POT ensured perfect final global apposition (0.4 ± 0.6% and 1.3 ± 1.3%, respectively, p = NS) compared to isolated BES (74.0 ± 7.6%, p < 0.05).
Conclusions:
This first experimental bench model of pPCI in a bifurcation quantified thrombus trapping and embolization. BES provided the best thrombus trapping, while SAS and BES+POT achieved better final stent apposition. These factors should be taken into account in selecting revascularization strategy.
