Analysis of Longitudinal Stent Deformation by 3DStent Technology: An In Vitro Pilot Study

Longitudinal stent deformation (LSD) is a classical pitfall of aorto-ostial percutaneous coronary intervention that carries out a higher risk for adverse outcomes when not corrected. This in vitro pilot study tested the performances of the new 3DStent (3DS) imaging mode (GE HealthCare) for the diagnosis of LSD.

A total of 41 coronary stents (diameter: 3.0 mm; length: 21-32 mm) were implanted in silicone tubes. LSD was created in 21 samples by crushing the proximal stent edge with a guiding catheter tip, whereas the others were left undeformed. All samples were analyzed by angiography methods including 3DS. The data were analyzed twice by 3 independent reviewers blinded to the characteristics of the samples. The diagnosis was based on the assessment of the following: (1) increased radio-opacity in the proximal stent section; (2) loss of stent borders parallelism; (3) loss of stent cells symmetry in its proximal part; (4) decreased stent length; and (5) decreased internal area in proximal stent section.

A total of 246 reconstructions were analyzed. The 3DS overall performances for LSD diagnosis were good: the global sensitivity and specificity were respectively 98.9% and 100% (positive predictive value: 100%; negative predictive value: 99%). The interobserver and intraobserver variabilities (Cohen's k) ranged from k = 0.95 to k = 1.0 for the LSD diagnosis. The different individual item sensitivities ranged between 92% and 98% and their specificities between 99% and 100%.

The 3DS imaging technology appeared to be efficient in identifying LSD in vitro. Whether these results could be translated in vivo needs to be assessed.