Coronary wallstents show significant late, postprocedural expansion despite implantation with adjunct high-pressure balloon inflations.
Adjunct high-pressure balloon inflations following the delivery of oversized self-expandable Wallstents may affect their implied late, postprocedural self-expansion. Consequently, we examined 15 "Magic" Wallstents, which were implanted following a strategy of stent oversizing and subsequent adjunct high-pressure balloon inflations (16 +/- 2 atm; all > or = 12 atm). The excellent radiographic visibility of this stent permitted reliable quantitative coronary angiographic measurement of both lumen and stent dimensions (before and after stenting, and at follow-up). At follow-up, extent and distribution of in-stent neointimal proliferation were evaluated with volumetric intravascular ultrasound. Between postintervention and follow-up examination, mean stent diameter increased from 3.7 +/- 0.4 to 4.2 +/- 0.4 mm (p <0.0001); there was no significant difference in late stent expansion between proximal, mid-, and distal stent subsegments. Late stent expansion showed a significant (reverse) relation to maximum balloon size (r = -0.56, p <0.04), but not with follow-up lumen size or late lumen loss. On average, 52 +/- 18% of the stent was filled with neointimal ingrowth; neointimal volume/cm stent length was 64 +/- 22 mm3. Both late stent expansion (r = 0.36, p <0.02) and maximum balloon pressure (r = 0.41, p <0.001) were related to neointimal volume/cm stent but not to follow-up lumen size. Thus, despite high-pressure implantation, Wallstents showed significant late self-expansion, which resulted in larger stent dimensions at follow-up that assisted in accommodating in-stent neointimal proliferation. Conversely, late stent expansion had a significant relation to the extent of in-stent neointimal ingrowth. Beneficial and disadvantageous effects of the late stent expansion appear to be balanced, because a relation to late lumen loss or follow-up lumen dimensions was not found to be present.
Thoraxcenter, University Hospital Rotterdam-Dijkzigt and Erasmus University Rotterdam, The Netherlands.
C
C
von Birgelen
S G
SG
Airiian
P J
PJ
de Feyter
D P
DP
Foley
W J
WJ
van der Giessen
P W
PW
Serruys
D000368:Aged; D000800:Angioplasty, Balloon / Q000379:methods*; D015986:Confounding Factors, Epidemiologic; D017023:Coronary Angiography / Q000379:methods; D003327:Coronary Disease / Q000000981:diagnostic imaging / Q000628:therapy*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D015607:Stents; D016896:Treatment Outcome; D018084:Ultrasonography, Interventional