Different treatment modalities for underexpanded stents-Effectiveness and outcomes: A practical guide

Area of Science:

• Interventional Cardiology
• Cardiovascular Devices

Background:

• Underexpanded stents are a significant complication of percutaneous coronary intervention (PCI).
• This complication is a major predictor of adverse events, including stent thrombosis and in-stent restenosis.
• Effective lesion preparation and plaque modification are crucial for preventing stent underexpansion.

Purpose of the Study:

• To provide an evidence-based summary of approaches to treating underexpanded stents.
• To evaluate various treatment modalities for underexpanded stents, focusing on luminal gain, complication rates, and technical aspects.
• To present a treatment algorithm for managing underexpanded stents.

Main Methods:

• Review of current literature and clinical experience with various treatment options for underexpanded stents.
• Evaluation of devices including ultrahigh pressure noncompliant balloons, excimer laser coronary angioplasty, rotational and orbital atherectomy, and intravascular lithotripsy.
• Formulation of a treatment algorithm based on gathered data and expert experience.

Main Results:

• Limited treatment options exist once stent underexpansion occurs.
• New devices offer improved approaches for complex calcified lesions and underexpanded stents.
• Specific modalities demonstrate varying degrees of efficacy and technical considerations for managing underexpanded stents.

Conclusions:

• Optimal lesion preparation is key to preventing stent underexpansion.
• A range of advanced devices are available for treating underexpanded stents, each with unique benefits and challenges.
• A structured treatment algorithm can guide clinicians in managing this complex PCI complication.