Longitudinal Stent Length Change after Intravascular Ultrasound-Guided Percutaneous Coronary Intervention with...

Contemporary thin-strut drug-eluting stents (DES) frequently undergo a change in longitudinal length after deployment. Contemporary intravascular ultrasound (IVUS)-guided in-vivo data from South-Asian populations remain limited.

We prospectively studied 80 consecutive de-novo coronary lesions treated by IVUS-guided percutaneous coronary intervention. Stent length was measured by edge-to-edge (E-E) and area-to-area (A-A) IVUS techniques, compared with the manufacturer box-stated length, and classified as elongated, shortened or unchanged.

Mean age was 58.3 ± 11.8 years (88.8% male). Stent length change occurred in 66 of 80 stents (82.5%) - elongation in 44 (55.0%), shortening in 22 (27.5%), unchanged in 14 (17.5%), with mean length differences of +1.23, -1.00, and +0.02 mm. Elongation exceeded 1 mm in 24 stents (30.0%) and 2 mm in 6 (7.5%); shortening exceeded 1 mm in 10 (12.5%). Reference lumen diameter (p=0.030) and area (p=0.011) differed across groups. On multivariable regression, both post-dilation pressure (p=0.004) and reference lumen diameter (p=0.026) remained independently associated with length change. All six stents with elongation >2 mm occurred at post-dilation pressures ≥20 atm; half were in left main-left anterior descending (LM-LAD) stents, and the three longest elongations were all in LM-LAD stents. Shortening was more than twice as common in LM-LAD than non-LM-LAD stents (45.0% vs 21.7%; Fisher p=0.080).

Longitudinal stent length change is common on post-PCI IVUS assessment, with elongation predominating. LM-LAD stents showed a bimodal pattern, with both the largest elongations and disproportionate shortenings clustering at this location. Higher post-dilation pressure and smaller reference vessel size were associated with greater elongation.