Evaluation of microcirculatory protection in percutaneous revascularisation: A stent implantation technique and...

Area of Science:

• Cardiovascular Medicine
• Interventional Cardiology
• Biomedical Engineering

Background:

• Coronary microvascular dysfunction (CMD) following percutaneous coronary intervention (PCI) is a significant concern, potentially leading to persistent angina.
• The method of stent implantation, including balloon inflation technique and material properties, may influence the development of post-PCI CMD.

Purpose of the Study:

• To investigate the impact of a slow versus standard drug-eluting stent (DES) implantation technique on coronary microvascular function after elective PCI.
• To evaluate secondary endpoints including myocardial injury and angina symptoms.

Main Methods:

• Thirty-six patients with stable angina undergoing elective PCI were randomized to a slow DES implantation technique or a standard technique.
• Coronary microvascular resistance (IMR) and coronary flow reserve (CFR) were assessed using PressureWire X thermodilution, alongside optical coherence tomography (OCT) pre- and post-PCI.
• Secondary outcomes included changes in cardiac troponin I (cTnI) and Seattle Angina Questionnaire (SAQ) scores.

Main Results:

• The slow DES implantation technique resulted in a significant improvement in the index of microvascular resistance (IMR), indicating less CMD (median difference -4.14, p=0.04).
• Coronary flow reserve (CFR) showed a numerical increase in the slow DES group, though not statistically significant (p=0.46).
• No significant differences were observed in changes in cardiac troponin I or SAQ scores at 3 months between the groups.

Conclusions:

• A slow stent implantation technique is associated with reduced coronary microvascular dysfunction after elective PCI in patients with stable angina.
• This finding suggests that optimizing stent deployment strategy can mitigate microvascular impairment.