AIMS: High rates of restenosis and stent thrombosis are still often observed after bifurcation stenting despite the recommended stent post-dilatation using the kissing balloon (KB) technique. We investigated the potential benefits of a final post-dilatation step in bifurcation stenting with a balloon that respects the natural diameter ratio of the proximal and distal vessels in bifurcations (Murray's law). METHODS AND RESULTS: Fourteen commercially available stents (Xience V, Taxus Liberté and Presillion) were deployed in a silicone model of a coronary bifurcation using a provisional stenting approach. After side branch (SB) ostium dilatation and KB inflation, stent geometry and strut apposition was analysed using micro-CT. A final proximal inflation step was then performed to post-dilate only the proximal segment of the main vessel (MV). KB inflation produces an asymmetrical dilatation of the stent in the proximal part of the bifurcation with a number of struts left malapposed in the MV. Using the proposed final proximal inflation (FPI) step reduces the average stent eccentricity index from 0.72 to 0.90 (p<0.001) and the percentage of malapposed struts in the proximal part of the MV from 33.4% to 0.6% (p=0.02), while increasing the minimum stent area from 6.8 mm² to 8.5 mm² (p < 0.0001). CONCLUSIONS: A final dilatation of the stent only in the MV proximal to the SB with a balloon sized according to the mother vessel is suggested to prevent stent malapposition and optimise stent deployment in bifurcation stenting.
AIMS: High rates of restenosis and stent thrombosis are still often observed after bifurcation stenting despite the recommended stent post-dilatation using the kissing balloon (KB) technique. We investigated the potential benefits of a final post-dilatation step in bifurcation stenting with a balloon that respects the natural diameter ratio of the proximal and distal vessels in bifurcations (Murray's law). METHODS AND RESULTS: Fourteen commercially available stents (Xience V, Taxus Liberté and Presillion) were deployed in a silicone model of a coronary bifurcation using a provisional stenting approach. After side branch (SB) ostium dilatation and KB inflation, stent geometry and strut apposition was analysed using micro-CT. A final proximal inflation step was then performed to post-dilate only the proximal segment of the main vessel (MV). KB inflation produces an asymmetrical dilatation of the stent in the proximal part of the bifurcation with a number of struts left malapposed in the MV. Using the proposed final proximal inflation (FPI) step reduces the average stent eccentricity index from 0.72 to 0.90 (p<0.001) and the percentage of malapposed struts in the proximal part of the MV from 33.4% to 0.6% (p=0.02), while increasing the minimum stent area from 6.8 mm² to 8.5 mm² (p < 0.0001). CONCLUSIONS: A final dilatation of the stent only in the MV proximal to the SB with a balloon sized according to the mother vessel is suggested to prevent stent malapposition and optimise stent deployment in bifurcation stenting.
Authors: Ilias Nikolakopoulos; Evangelia Vemmou; Judit Karacsonyi; Lorenzo Azzalini; Brian A Bergmark; Yiannis S Chatzizisis; Allison B Hall; Jason Wollmuth; Kevin Croce; Hani Jneid; Bavana V Rangan; M Nicholas Burke; Emmanouil S Brilakis Journal: J Invasive Cardiol Date: 2022-01 Impact factor: 2.022
Authors: Gianluca Rigatelli; Fabio Dell'Avvocata; Marco Zuin; Sara Giatti; Khanh Duong; Trung Pham; Nguyen Si Tuan; Dobrin Vassiliev; Ramesh Daggubati; Thach Nguyen Journal: J Transl Int Med Date: 2017-12-29