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Contemporary Use of Post-Dilatation for Stent Optimization During Percutaneous Coronary Intervention; Results From
K A J van Beek1, M J C Timmermans2, L Derks2
1Heart Centre, Catharina Hospital, Eindhoven, The Netherlands.
Insights
Post-dilatation with non-compliant balloons is used in about half of percutaneous coronary interventions (PCI) in the Netherlands. Its use varies significantly among hospitals and operators, often increasing with complex PCI cases and advanced imaging techniques.
Area of Science:
- Cardiology
- Interventional Cardiology
- Medical Device Technology
Background:
- Post-dilatation with non-compliant (NC) balloons is a technique used to optimize percutaneous coronary intervention (PCI) outcomes.
- There is currently no consensus on the routine use of post-dilatation due to limited evidence on its impact on adverse clinical endpoints.
Purpose of the Study:
- To investigate the contemporary practice patterns of post-dilatation in percutaneous coronary intervention (PCI).
- To assess the frequency and variability of post-dilatation use across different hospitals and operators.
Main Methods:
- Analysis of patient data from the Netherlands Heart Registration for PCI procedures performed between Q4 2020 and Q3 2021.
- Primary endpoint: rate of post-dilatation with an NC balloon.
- Secondary endpoints: comparison of baseline and procedural characteristics between patients who received and did not receive post-dilatation.
Main Results:
- Out of 12,960 patients, 49.9% underwent post-dilatation.
- Significant variation in post-dilatation rates observed between hospitals (29.3%–82.7%) and operators (15.9%–90.5%).
- Post-dilatation was less frequent in ST-elevation myocardial infarction and out-of-hospital cardiac arrest cases, but more frequent in complex PCI, long stent lengths, and when intracoronary imaging or calcium modification was used (79.4% with imaging).
Conclusions:
- Stent optimization with post-dilatation using NC balloons is performed in approximately half of PCI patients in the Netherlands.
- Practices vary considerably across institutions and among individual operators.
- Increased utilization is noted in complex PCI scenarios, particularly when intracoronary imaging or calcium modification techniques are employed.
Backgrounds:
Post-dilatation after stenting with a non-compliant (NC) balloon can be used to improve overall percutaneous coronary intervention (PCI) result. Due to lack of evidence on the effect of post-dilatation on adverse clinical endpoints there is no consensus whether post-dilatation should be used routinely. The aim of the current study was to determine the contemporary practice of post-dilatation.
Methods:
This study included patients from the Netherlands Heart Registration who underwent PCI between the 4th quarter of 2020 and the 3rd quarter of 2021. The primary endpoint was the rate of post-dilatation with a NC balloon. Secondary endpoints included differences in baseline and procedural characteristics of patients that received post-dilatation and patients that did not receive post-dilatation.
Results:
Out of 12,960 patients from 11 hospitals, 49.9% underwent post-dilatation. There was a variety in post-dilatation between hospitals ranging from 29.3% to 82.7% and among operators ranging from 15.9% to 90.5%. Post-dilatation was used less frequent in patients presenting with ST-elevation myocardial infarction or out of hospital cardiac arrest. Multivessel and left main PCI, long stent length and use of intracoronary imaging and calcium modification were associated with increased use of post-dilatation. When imaging was used, the percentage of post-dilatation was 79.4%.
Conclusions:
In the Netherlands, stent optimization with post-dilatation using NC balloon is performed in only half of the patients undergoing PCI, with variations in frequency across centres and operators. Post-dilatation is more often used in cases of complex PCI and when intracoronary imaging or calcium modification techniques are used.
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