title: Anchoring barbs and balloon expandable stents: what is the risk of perforation and failed stent deployment?
abstract: OBJECTIVE
  Balloon expandable stents may on occasion be deployed in close proximity to the anchoring barbs of endovascular grafts. The aim of this study was to determine the risk and effect of balloon perforation by anchoring barbs and to assess whether these risks are different if the balloon is protected by a covered stent mounted upon it.
  
  
  METHODS
  A bench-top model was developed to mimic the penetration of anchoring barbs into the lumen of medium sized blood vessels. The model allowed variation of angle and depth of vessel penetration. Both bare balloons and those with covered stents mounted upon them were tested in the model to determine whether there was a risk of perforation and which factors increased or decreased this risk.
  
  
  RESULTS
  All combinations of barb angle and depth caused balloon perforation but this was most marked when the barb was placed perpendicular to the long axis of the balloon. When the deployment of covered stents was attempted balloon perforation occurred in some cases but full stent deployment was achieved in all cases where the perforation was in the portion of the balloon covered by the stent. The only situation in which stent deployment failed was where the barb was intentionally placed in the uncovered portion of the balloon. This resulted in only partial deployment of the stent.
  
  
  CONCLUSIONS
  Balloon rupture is a distinct possibility when deploying balloon-expandable stents in close proximity to anchoring barbs. Care should be taken in this circumstance to ensure that the barb is well away from the uncovered portion of the balloon.
authors: Department of Cardiovascular Sciences, University of Leicester, UK.
authors: M J
authors: MJ
authors: Bown
authors: G J
authors: GJ
authors: Harrison
authors: T V
authors: TV
authors: How
authors: J A
authors: JA
authors: Brennan
authors: R K
authors: RK
authors: Fisher
authors: S R
authors: SR
authors: Vallabhaneni
authors: R G
authors: RG
authors: McWilliams
mesh_terms: D000800:Angioplasty, Balloon / Q000009:adverse effects* / Q000295:instrumentation*; D001158:Arteries / Q000033:anatomy & histology / Q000601:surgery*; D001807:Blood Vessel Prosthesis; D019917:Blood Vessel Prosthesis Implantation / Q000009:adverse effects* / Q000295:instrumentation*; D019544:Equipment Failure Analysis; D006801:Humans; D008422:Materials Testing; D008953:Models, Anatomic; D011312:Pressure; D011474:Prosthesis Design; D011475:Prosthesis Failure; D018570:Risk Assessment; D012307:Risk Factors; D015607:Stents; D013997:Time Factors