title: Incidence and mechanisms of longitudinal stent deformation associated with Biomatrix, Resolute, Element, and Xience stents: Angiographic and case-by-case review of 1,800 PCIs.
abstract: BACKGROUND
  There is conflicting evidence regarding the incidence of longitudinal stent deformation (LSD) in contemporary practice.
  
  
  RESULTS
  To assess the incidence and mechanism of LSD across commonly used DES platforms, we performed a case-by-case review of 1,800 PCI cases involving 450 consecutive procedures using Biomatrix Flex, Resolute Integrity, Promus Element, and Xience V stents, respectively, between January 2009 and December 2011. LSD was detected in a higher proportion with Promus Element [15 (3.1%)] compared with other platforms (Xience V [4 (0.9%)], Biomatrix [3 (0.7%)], Resolute [3 (0.7%)]; P = 0.002). LSD was characterized as guide catheter/guide extension induced, or as impact from secondary devices such as postdilatation balloons or IVUS catheters. The incidence of guide catheter/guide extension LSD was similar across platforms; (Promus Element [5 (1.1%)], Xience V [4 (0.9%)], Biomatrix [3 (0.7%)], Resolute [3 (0.7%)]; P = 0.85). Secondary device LSD occurred exclusively with Promus Element (9/450 cases [2%] (P < 0.0001). Re-entering the deformed stent was more difficult in cases of secondary device LSD (6/9 compared with 0/12 treated cases; P < 0.001). Univariate predictors of LSD were previous CABG, culprit vessel, ostial involvement, and lesion tortuosity. Multivariate predictors of LSD were the Promus Element stent (OR 5.53 CI[1.54-19.85]), Guideliner use (OR 22.09 CI[4.73-103]), postdilation balloons (OR 5.47 CI[1.31-22.81]) and number of stents deployed (OR 2.06 CI[1.45-2.9].
  
  
  CONCLUSIONS
  LSD is more common than previously reported. LSD by a guide catheter/guide extension occurred equally with all platforms, however, LSD associated with secondary devices only occurred with the Element stent. These findings have important implications regarding current and future stent designs.
authors.affiliation: Manchester Heart Centre, Manchester Royal Infirmary, Manchester, M139WL, United Kingdom.|Cardiovascular Institute, University of Manchester, Manchester, M13 9PT, United Kingdom.
authors.forename: Samer
authors.initials: S
authors.lastname: Arnous
authors.affiliation: Manchester Heart Centre, Manchester Royal Infirmary, Manchester, M139WL, United Kingdom.|Cardiovascular Institute, University of Manchester, Manchester, M13 9PT, United Kingdom.
authors.forename: Nizar
authors.initials: N
authors.lastname: Shakhshir
authors.affiliation: Manchester Heart Centre, Manchester Royal Infirmary, Manchester, M139WL, United Kingdom.|Cardiovascular Institute, University of Manchester, Manchester, M13 9PT, United Kingdom.
authors.forename: Andrew
authors.initials: A
authors.lastname: Wiper
authors.affiliation: Manchester Heart Centre, Manchester Royal Infirmary, Manchester, M139WL, United Kingdom.|Cardiovascular Institute, University of Manchester, Manchester, M13 9PT, United Kingdom.
authors.forename: Farzin-Farth
authors.initials: FF
authors.lastname: Ordoubadi
authors.affiliation: Manchester Heart Centre, Manchester Royal Infirmary, Manchester, M139WL, United Kingdom.|Cardiovascular Institute, University of Manchester, Manchester, M13 9PT, United Kingdom.
authors.forename: Paul
authors.initials: P
authors.lastname: Williams
authors.affiliation: Manchester Heart Centre, Manchester Royal Infirmary, Manchester, M139WL, United Kingdom.|Cardiovascular Institute, University of Manchester, Manchester, M13 9PT, United Kingdom.
authors.forename: Bernard
authors.initials: B
authors.lastname: Clarke
authors.affiliation: Manchester Heart Centre, Manchester Royal Infirmary, Manchester, M139WL, United Kingdom.|Cardiovascular Institute, University of Manchester, Manchester, M13 9PT, United Kingdom.
authors.forename: Vaikom
authors.initials: V
authors.lastname: Mahadavan
authors.affiliation: Manchester Heart Centre, Manchester Royal Infirmary, Manchester, M139WL, United Kingdom.|Cardiovascular Institute, University of Manchester, Manchester, M13 9PT, United Kingdom.
authors.forename: Magdi
authors.initials: M
authors.lastname: El-Omar
authors.affiliation: Manchester Heart Centre, Manchester Royal Infirmary, Manchester, M139WL, United Kingdom.|Cardiovascular Institute, University of Manchester, Manchester, M13 9PT, United Kingdom.
authors.forename: Mamas
authors.initials: M
authors.lastname: Mamas
authors.affiliation: Manchester Heart Centre, Manchester Royal Infirmary, Manchester, M139WL, United Kingdom.|Cardiovascular Institute, University of Manchester, Manchester, M13 9PT, United Kingdom.
authors.forename: Douglas
authors.initials: D
authors.lastname: Fraser
mesh_terms: D000368:Aged; D000704:Analysis of Variance; D015906:Angioplasty, Balloon, Coronary / Q000009:adverse effects / Q000379:methods*; D016009:Chi-Square Distribution; D015331:Cohort Studies; D017023:Coronary Angiography / Q000379:methods; D003327:Coronary Disease / Q000000981:diagnostic imaging* / Q000628:therapy*; D016208:Databases, Factual; D019544:Equipment Failure Analysis / Q000379:methods*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D015994:Incidence; D008297:Male; D008875:Middle Aged; D062645:Percutaneous Coronary Intervention / Q000295:instrumentation; D011237:Predictive Value of Tests; D011474:Prosthesis Design; D011475:Prosthesis Failure; D012189:Retrospective Studies; D018709:Statistics, Nonparametric; D015607:Stents / Q000009:adverse effects*; D016896:Treatment Outcome; D006113:United Kingdom
keywords: drug-eluting stents; longitudinal stent deformation; percutaneous coronary intervention