Management of Coronary Stent Underexpansion

Area of Science:

• Cardiovascular Interventions
• Interventional Cardiology
• Medical Device Technology

Background:

• Coronary stent underexpansion is a significant limitation of percutaneous coronary intervention (PCI).
• It leads to inadequate luminal gain, increasing risks of stent thrombosis, restenosis, myocardial infarction, and mortality.
• Factors include calcification, poor lesion prep, and suboptimal deployment.

Purpose of the Study:

• To review current evidence, clinical experience, and treatment strategies for coronary stent underexpansion.
• To provide practical guidance for optimizing PCI and patient outcomes.
• To address the lack of consensus on optimal treatment due to limited prospective studies.

Main Methods:

• Comprehensive literature review of existing evidence and clinical experience.
• Analysis of contributing factors and challenges in managing underexpanded stents.
• Evaluation of the role of intravascular imaging modalities (IVUS, OCT) in diagnosis and management.

Main Results:

• Stent underexpansion is linked to adverse clinical events, including restenosis and thrombosis.
• Severe calcification and complex plaque morphology present challenges for stent optimization.
• Intravascular imaging is crucial for accurate diagnosis and guiding treatment strategies.

Conclusions:

• Optimal treatment for stent underexpansion remains undefined due to a lack of large prospective trials.
• Intravascular imaging aids in understanding mechanisms and tailoring interventions.
• Further research is needed to establish evidence-based guidelines for managing stent underexpansion.