Nonrandomized comparison of coronary stenting under intravascular ultrasound guidance of direct stenting without predilation versus conventional predilation with a semi-compliant balloon versus predilation with a new scoring balloon.
This study was conducted to determine the influence of lesion preparation using the AngioSculpt balloon on final stent expansion. Stent expansion remains an important predictor of restenosis and subacute thrombosis, even in the drug-eluting stent (DES) era. In these patients, the role of different predilation strategies has yet to be established. Two hundred ninety-nine consecutive de novo lesions treated with 1 >2.5-mm DES (Cypher or Taxus) under intravascular ultrasound guidance without postdilation, using 3 implantation strategies, were studied: (1) direct stenting without predilation (n = 145), (2) predilation with a conventional semi-compliant balloon (n = 117), and (3) predilation with the AngioSculpt balloon (n = 37). Stent expansion was defined as the ratio of intravascular ultrasound-measured minimum stent diameter and minimum stent area to the manufacturer's predicted stent diameter and area. These ratios were larger after AngioSculpt predilation, and a greater percentage of stents had final minimum stent areas >5.0 mm(2) (another commonly accepted criterion of adequate DES expansion). Lesion morphology, stent and lesion length, and reference vessel size did not affect DES expansion. In conclusion, in this observational, nonrandomized study, pretreatment with the AngioSculpt balloon enhanced stent expansion and minimized the difference between predicted and achieved stent dimensions.
de Ribamar Costa
Jose
J
Cardiovascular Research Foundation and Columbia University Medical Center, New York, New York, USA.
Mintz
Gary S
GS
Carlier
Stéphane G
SG
Mehran
Roxana
R
Teirstein
Paul
P
Sano
Koichi
K
Liu
Xuebo
X
Lui
Joanna
J
Na
Yingbo
Y
Castellanos
Celia
C
Biro
Sinan
S
Dani
Lockeshi
L
Rinker
Jason
J
Moussa
Issam
I
Dangas
George
G
Lansky
Alexandra J
AJ
Kreps
Edward M
EM
Collins
Michael
M
Stone
Gregg W
GW
Moses
Jeffrey W
JW
Leon
Martin B
MB
D000368:Aged; D000497:Alloys; D015906:Angioplasty, Balloon, Coronary / Q000295:instrumentation* / Q000379:methods; D002317:Cardiovascular Agents / Q000627:therapeutic use; D003331:Coronary Vessels / Q000000981:diagnostic imaging* / Q000473:pathology; D019160:Endosonography; D004867:Equipment Design; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D017239:Paclitaxel / Q000627:therapeutic use; D011312:Pressure; D011446:Prospective Studies; D020123:Sirolimus / Q000627:therapeutic use; D015607:Stents; D013499:Surface Properties; D018084:Ultrasonography, Interventional
D000497:Alloys; D002317:Cardiovascular Agents; C013616:nitinol; D017239:Paclitaxel; D020123:Sirolimus