title: Optimization of stent implantation using a high pressure inflation protocol.
abstract: BACKGROUND
  High-pressure inflation is the universal standard for stent deployment but a specific protocol for its use is lacking. We developed a standardized "pressure optimization protocol" (POP) using time to inflation pressure stability as an endpoint for determining the required duration of stent inflation.
  
  
  OBJECTIVE
  The primary study purpose was to determine the stent inflation time (IT) in a large patient cohort using the standardized inflation protocol, to correlate various patient and lesion characteristics with IT, and ascertain in an in vitro study the time for pressure accommodation within an inflation system.
  
  
  METHODS
  Six hundred fifteen stent implants in 435 patients were studied. Multivariate analysis was performed to determine predictors of longer ITs. In an in vitro study, various stents and balloons were inflated in air to determine the pressure accommodation time of the inflation system.
  
  
  RESULTS
  The mean stent IT was 104 ± 41 sec (range 30-380 sec). Stent length was the only predictor of prolonged stent inflation. The "accommodation time" in vitro of the stent inflation system itself was 33 ± 24 sec. The protocol was safe requiring premature inflation termination in <3% of stent implants. No serious adverse events occurred.
  
  
  CONCLUSIONS
  Achieving stable inflation pressure requires on average over 100 sec and may require several minutes in individual cases. Stent length increases IT. These results suggest that the widespread practice of rapid inflation/deflation may not be sufficient to fully expand the stent and that the use of a pressure stability protocol will allow for safe, predictable, and more complete stent deployment. © 2015 Wiley Periodicals, Inc.
authors.affiliation: Division of Cardiology, University of Arkansas for Medical Sciences, Little Rock, Arkansas.
authors.forename: Srikanth
authors.initials: S
authors.lastname: Vallurupalli
authors.affiliation: Division of Cardiology, University of Arkansas for Medical Sciences, Little Rock, Arkansas.
authors.forename: Amit
authors.initials: A
authors.lastname: Bahia
authors.affiliation: Division of Cardiology, University of Arkansas for Medical Sciences, Little Rock, Arkansas.
authors.forename: Ernesto
authors.initials: E
authors.lastname: Ruiz-Rodriguez
authors.affiliation: Division of Cardiology, University of Arkansas for Medical Sciences, Little Rock, Arkansas.|Central Arkansas Veterans Healthcare System, Little Rock, Arkansas.
authors.forename: Zubair
authors.initials: Z
authors.lastname: Ahmed
authors.affiliation: Division of Cardiology, University of Arkansas for Medical Sciences, Little Rock, Arkansas.|Central Arkansas Veterans Healthcare System, Little Rock, Arkansas.
authors.forename: Abdul
authors.initials: A
authors.lastname: Hakeem
authors.affiliation: Division of Cardiology, University of Arkansas for Medical Sciences, Little Rock, Arkansas.|Central Arkansas Veterans Healthcare System, Little Rock, Arkansas.
authors.forename: Barry F
authors.initials: BF
authors.lastname: Uretsky
mesh_terms: D000368:Aged; D017023:Coronary Angiography; D003327:Coronary Disease / Q000175:diagnosis / Q000601:surgery*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D062645:Percutaneous Coronary Intervention / Q000379:methods* / Q000592:standards; D011312:Pressure; D012189:Retrospective Studies; D015607:Stents; D016896:Treatment Outcome
keywords: angioplasty; coronary stenting; percutaneous coronary intervention; stenting technique