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

Salvatore Colangelo1, Riccardo Mangione1, Mario Iannaccone1

  • 1Cardiovascular Intervention, San Giovanni Bosco Hospital, Torino, Italy.

Catheterization and Cardiovascular Interventions : Official Journal of the Society for Cardiac Angiography & Interventions
|July 25, 2025
PubMed

Insights

This study found that polymer-free drug-eluting stents (DES) significantly reduce adverse events during complex percutaneous coronary intervention (PCI) when used with guiding-extension catheters (GECs). The polymer-free DES demonstrated superior safety and efficacy in preventing stent damage and improving patient outcomes.

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.
Abstract

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