title: Stent longitudinal strength assessed using point compression: insights from a second-generation, clinically related bench test.
abstract: BACKGROUND
  Stent longitudinal distortion, while infrequent, can lead to adverse clinical events. Our first bench comparison of susceptibility of different stent designs to distortion applied force to the entire circumference of the proximal stent hoop. The test increased understanding of stent design and led to recommendations for design change in some. Our second-generation test more closely mimics clinical scenarios by applying force to a point on the proximal hoop of a malapposed stent.
  
  
  RESULTS
  Each 3-mm-diameter stent was secured in a test apparatus so that its proximal 5 mm was malapposed in a 3.5-mm tube. An instron applied force to the proximal hoop of each of 5 examples of each of 6 stent designs using a narrow rod so that force applied and distance compressed could be measured. Hoops on the side of the force were pushed together, became malapposed, and obstructed the lumen. In addition, the proximal stent hoop tilted causing malapposition, the contralateral side of the stent from the applied force causing lumen obstruction.
  
  
  CONCLUSIONS
  This second-generation, more clinically relevant test showed the Biomatrix Flex was the most resistant to deformation and the Element the most easily deformed. The addition of more connectors between the proximal hoops in the Promus Premier design has reduced the potential for distortion when compared with the Element, so that distortion was similar to the Vision, Multi-Link 8, and Integrity designs. The test also provided insight into the way in which stents are likely to distort in clinical practice.
authors.affiliation: From the Mercy Angiography, Auckland, New Zealand (J.A.O., B.W., B.U., M.W.I.W.); and Cardiology Department, Auckland City Hospital, Auckland, New Zealand (J.A.O., J.W., M.W.I.W.).
authors.forename: John A
authors.initials: JA
authors.lastname: Ormiston
authors.forename: Bruce
authors.initials: B
authors.lastname: Webber
authors.forename: Ben
authors.initials: B
authors.lastname: Ubod
authors.forename: Jonathon
authors.initials: J
authors.lastname: White
authors.forename: Mark W I
authors.initials: MW
authors.lastname: Webster
mesh_terms: D019245:Compressive Strength; D054855:Drug-Eluting Stents / Q000706:statistics & numerical data; D019544:Equipment Failure Analysis; D006801:Humans; D011474:Prosthesis Design; D011475:Prosthesis Failure; D019919:Prosthesis Implantation; D013314:Stress, Mechanical; D055114:X-Ray Microtomography
keywords: drug-eluting stents; stents