Adjunctive balloon postdilatation after stent deployment: is it still necessary with drug-eluting stents?
Deployment of bare metal stents (BMS) with current stent delivery systems is often associated with suboptimal stent expansion. Adjunctive postdilatation with noncompliant balloons has improved stent expansion with BMS and has been associated with less need for target vessel revascularization (TVR). Drug-eluting stents (DES) have proven highly effective in reducing restenosis and TVR and are now being used in the great majority of percutaneous coronary interventions. Because of the very low rates of TVR with DES, many operators have felt that postdilatation may no longer be necessary. In this review, we present data showing that stent expansion of DES (like BMS) using current stent delivery systems is frequently suboptimal. Furthermore, smaller mimimal stent area (MSA) and stent underexpansion following deployment of DES are strong predictors of stent thrombosis and TVR. Adjunctive postdilatation with noncompliant balloons can increase MSA and decrease the frequency of suboptimal stent deployment and potentially can reduce the frequency of stent thrombosis and TVR. Despite the lack of evidence from randomized clinical trials, we believe the observational data support the use of adjunctive balloon postdilatation following deployment of DES in the great majority of patients.
Brodie
Bruce R
BR
Moses Cone Heart and Vascular Center, LeBauer Cardiovascular Research Foundation, Greensboro, North Carolina 27401, USA.
D015906:Angioplasty, Balloon, Coronary; D019917:Blood Vessel Prosthesis Implantation; D003324:Coronary Artery Disease / Q000601:surgery / Q000628:therapy*; D023903:Coronary Restenosis / Q000503:physiopathology / Q000517:prevention & control*; D003328:Coronary Thrombosis / Q000503:physiopathology / Q000517:prevention & control*; D016503:Drug Delivery Systems; D006801:Humans; D015607:Stents; D013997:Time Factors; D016896:Treatment Outcome