Interaction Between Guiding-Extension Catheter and Drug-Eluting Stents: Always Safe or Sometimes Harmful?

Area of Science:

• Cardiovascular Medicine
• Interventional Cardiology
• Biomaterials Science

Background:

• Guiding-extension catheters (GECs) enhance support during complex percutaneous coronary intervention (PCI).
• GECs can increase friction with drug-eluting stents (DES), potentially damaging stent struts.
• This interaction risk necessitates evaluating alternative DES designs.

Purpose of the Study:

• To compare the performance of a polymer-free DES (Amphilimus Cre8 EVO) against surface-coated DES.
• To assess if the polymer-free DES's abluminal reservoir technology mitigates abrasion risk within GECs.
• To evaluate the safety and efficacy of different DES types during complex PCI with GEC use.

Main Methods:

• A prospective study enrolled 218 patients undergoing complex PCI with DES and GEC use.
• Patients were divided into two groups: polymer-free DES (Group A, 39 patients) and other DES (Group B, 179 patients).
• A device-oriented composite endpoint (DoCE) was assessed at one-year follow-up, including cardiovascular death, target vessel MI, and target lesion revascularization.

Main Results:

• Event-free survival from DoCE was significantly higher in the polymer-free DES group (97.4%) compared to the other DES group (85.5%) (Log rank = 0.027).
• A significant difference in mean stent length was observed (Group A: 52.4 ± 38.6 mm vs. Group B: 40.4 ± 22.6 mm, p=0.01).
• No significant differences were noted in other clinical or procedural variables.

Conclusions:

• The polymer-free DES demonstrated superior one-year outcomes in preventing DoCE during complex PCI with GECs.
• The abluminal reservoir design of the polymer-free DES may prevent adverse interactions with GECs.
• This suggests polymer-free DES are a preferred option when GECs are employed in complex PCI procedures.