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Previous studies have demonstrated that high–pressure stent deployment reduces the incidence of stent thrombosis (ST) and probably decreases in–stent restenosis. However, there is no consensus as to the protocol for high–pressure inflation.
In patients undergoing routine PCI and in an attempt to simulate clinical practice, high–pressure rapid inflation/deflation sequence was performed for stent deployment, guided by angiography only to ensure no residual stenosis. OCT was then performed to evaluate stent apposition and expansion. Using the same balloon at the same pressure, prolonged inflation within the stent was then maintained until there was constancy of inflation pressure for 30 sec and OCT was then repeated.
27,343 stent struts were evaluated in 12 patients with inflation pressure in both groups of 17.0 +1.0 atm. The mean stent size was 2.83 + 0.26 × 27 + 9.31 mm.
These data demonstrate that prolonged high–pressure balloon inflation until inflation is maintained provides added benefit for stent expansion and apposition relative to high–pressure inflation with a rapid inflation–deflation sequence. Further study is required to determine if these results translate to improvements in patient outcomes.
|Rapid Inflation/Deflation||Prolonged Inflation||P-Value=|
|Mean inflation time (sec)||28+18||206+120||0.0002|
|Struts evaluated/pt (n=)||1159+363||1119 +353||NS|
|In-stent minimal luminal area(mm2)||6.63+1.85||7.83+2.45||0.0003|
|In-stent minimal luminal diameter(mm)||2.75+0.44||3.0+0.5||<0.0001|
|Struts malapposed (n=)||88+75||45+41||0.005|
|% struts malapposed||8.1+6.8||4.8+5.6||0.002|
|Maximal stent malapposition (mm)||0.43+0.20||0.31+0.20||0.001|
Poster Sessions, Expo North
Sunday, March 10, 2013, 9:45 a.m.–10:30 a.m.
Session Title: Intravascular Imaging: IVUS and OCT
Abstract Category: 38. TCT@ACC–i2: Intravascular Imaging and Physiology
Presentation Number: 2108–240
- 2013 American College of Cardiology Foundation