title: The impact of routine and intravascular ultrasound-guided high-pressure postdilatation after drug-eluting stent deployment: the STent OPtimization (STOP) study.
abstract: OBJECTIVE
  Drug-eluting stent (DES) implantations with low final cross-sectional area (CSA) are associated with adverse clinical outcomes. However, there is no guidance to facilitate optimal stent deployment (SD). The stent optimization (STOP) study was performed to assess DES routine postdilatation (PD) following implantation with intravascular ultrasound (IVUS) guidance.
  
  
  METHODS
  Forty-eight patients were included in this single-center prospective study. All DESs were deployed at 16 atm for 20 seconds and underwent routine non-compliant balloon PD (minimum 20 atm for 10 seconds). IVUS performed after SD (blinded) and PD (unblinded) measured CSA at 4 stent reference points. Optimal deployment was defined as distal and proximal stent CSA ≥60% distal and proximal reference CSA; mid and minimum stent CSA ≥70% of distal reference CSA. All per-protocol criteria were required to define optimal SD. Suboptimally deployed DESs underwent further PD with IVUS guidance (IVPD).
  
  
  RESULTS
  Fifty-two lesions were treated in 48 patients. CSA increased by 20% following PD. STOP criteria were only achieved in 21% of DESs after SD compared to 54% after PD. IVPD was performed in 20 DESs, which increased CSA by a further 21%. STOP criteria were eventually attained in 81% cases (P<.001 for all comparisons).
  
  
  CONCLUSIONS
  DES deployment leads to suboptimal deployment, which can be optimized by routine PD. IVUS identifies DES implantations that benefit from further PD. Optimizing final DES-CSA may have longterm clinical benefits, although a randomized study is required.
authors.affiliation: Dorset Heart Centre, Royal Bournemouth Hospital, Castle Lane East, Bournemouth, BH7 7DW, United Kingdom. terry.levy@rbch.nhs.uk.
authors.forename: Omar
authors.initials: O
authors.lastname: Rana
authors.forename: Nimit C
authors.initials: NC
authors.lastname: Shah
authors.forename: Samuel
authors.initials: S
authors.lastname: Wilson
authors.forename: Rosie
authors.initials: R
authors.lastname: Swallow
authors.forename: Peter
authors.initials: P
authors.lastname: O'Kane
authors.forename: Terry
authors.initials: T
authors.lastname: Levy
mesh_terms: D015906:Angioplasty, Balloon, Coronary / Q000295:instrumentation / Q000379:methods*; D015331:Cohort Studies; D017023:Coronary Angiography; D003324:Coronary Artery Disease / Q000000981:diagnostic imaging / Q000628:therapy*; D023921:Coronary Stenosis / Q000000981:diagnostic imaging* / Q000628:therapy*; D054855:Drug-Eluting Stents; D011446:Prospective Studies; D019233:Retreatment; D016037:Single-Blind Method; D018084:Ultrasonography, Interventional / Q000295:instrumentation / Q000379:methods*