Effectiveness of the Repeated 3-time-balloon-inflation Method in Reducing Coronary Stent Edge Dissection

Overview

Journal Heart Vessels

Specialty Cardiology & Vascular Diseases

Date 2024 Dec 24

PMID 39718636

Authors

Ryosuke Amisaki

Tomomi Watanabe

Satoshi Kobara

Kazuhiro Yamamoto

Affiliations

Soon will be listed here.

Abstract

The optimal procedural protocol for coronary stent deployment remains undetermined. Post-dilation with a high-pressure balloon is often performed to optimize the stent expansion. However, high-pressure dilation also carries the potential risk of coronary artery injury. A previous in vitro study reported that multiple-times balloon inflation at the same pressure resulted in better stent expansion compared to one-time balloon inflation. In our facility, we frequently perform the repeated 3-time-balloon-inflation method, wherein the stent delivery balloon was inflated 3 times at nominal pressure to deploy the stent, to improve stent expansion without high-pressure balloon inflation. Although this method seems effective in avoiding excessive high-pressure dilation, its clinical data are insufficient. In this study, we investigated the clinical outcomes of the repeated 3-time-balloon-inflation method. This retrospective study included 370 patients with 467 stented coronary lesions. These subjects were divided into two groups: one with standard balloon inflation and the other with repeated 3-time balloon inflation, and treatment outcomes were compared. The repeated 3-time-balloon-inflation group had 254 lesions, and the standard-balloon-inflation group had 213 lesions. Stent edge dissection occurred in 6 lesions (2.8%) in the standard-balloon-inflation group, whereas did not occur in the repeated 3-time-balloon-inflation group. A statistically significant difference remained even after propensity score matching (p = 0.040). The final minimum stent area and long-term clinical outcomes were not significantly different between the two groups. The repeated 3-time-balloon-inflation method may reduce stent edge dissection while demonstrating comparable minimal stent area and long-term outcomes to the standard-balloon-inflation method.

References

Saito Y, Kobayashi Y . Contemporary coronary drug-eluting and coated stents: an updated mini-review (2023). Cardiovasc Interv Ther. 2023; 39(1):15-17. DOI: 10.1007/s12928-023-00954-7. View

Dores H, Raposo L, Teles R, Machado C, Leal S, Goncalves P . Stent thrombosis with second- versus first-generation drug-eluting stents in real-world percutaneous coronary intervention: analysis of 3806 consecutive procedures from a large-volume single-center prospective registry. J Invasive Cardiol. 2013; 25(7):330-6. View

Nabel E, Braunwald E . A tale of coronary artery disease and myocardial infarction. N Engl J Med. 2012; 366(1):54-63. DOI: 10.1056/NEJMra1112570. View

Colombo A, Hall P, Nakamura S, Almagor Y, Maiello L, Martini G . Intracoronary stenting without anticoagulation accomplished with intravascular ultrasound guidance. Circulation. 1995; 91(6):1676-88. DOI: 10.1161/01.cir.91.6.1676. View

Stone G, St Goar F, Hodgson J, Fitzgerald P, Alderman E, Yock P . Analysis of the relation between stent implantation pressure and expansion. Optimal Stent Implantation (OSTI) Investigators. Am J Cardiol. 1999; 83(9):1397-400, A8. DOI: 10.1016/s0002-9149(99)00104-6. View

Hoffmann R, Haager P, Mintz G, Kerckhoff G, Schwarz R, Franke A . The impact of high pressure vs low pressure stent implantation on intimal hyperplasia and follow-up lumen dimensions; results of a randomized trial. Eur Heart J. 2001; 22(21):2015-24. DOI: 10.1053/euhj.2001.2609. View

Javaid A, Chu W, Cheneau E, Clavijo L, Satler L, Kent K . Comparison of paclitaxel-eluting stent and sirolimus-eluting stent expansion at incremental delivery pressures. Cardiovasc Revasc Med. 2006; 7(4):208-11. DOI: 10.1016/j.carrev.2006.09.002. View

Muraoka Y, Sonoda S, Tsuda Y, Tanaka S, Okazaki M, Otsuji Y . Effect of intravascular ultrasound-guided adjuvant high-pressure non-compliant balloon post-dilation after drug-eluting stent implantation. Heart Vessels. 2010; 26(6):565-71. DOI: 10.1007/s00380-010-0094-0. View

Al-Mukhaini M, Panduranga P, Sulaiman K, Riyami A, Deeb M, Riyami M . Coronary perforation and covered stents: an update and review. Heart Views. 2011; 12(2):63-70. PMC: 3221194. DOI: 10.4103/1995-705X.86017. View

10.

Hendry C, Fraser D, Eichhofer J, Mamas M, Fath-Ordoubadi F, El-Omar M . Coronary perforation in the drug-eluting stent era: incidence, risk factors, management and outcome: the UK experience. EuroIntervention. 2012; 8(1):79-86. DOI: 10.4244/EIJV8I1A13. View

11.

Kuno T, Ohata T, Nakamaru R, Sawano M, Kodaira M, Numasawa Y . Long-term outcomes of periprocedural coronary dissection and perforation for patients undergoing percutaneous coronary intervention in a Japanese multicenter registry. Sci Rep. 2023; 13(1):20318. PMC: 10662469. DOI: 10.1038/s41598-023-47444-7. View

12.

Skowronski J, Wolny R, Jastrzebski J, Tyczynski P, Szlazak K, Pregowski J . Impact of the Balloon Inflation Time and Pattern on the Coronary Stent Expansion. J Interv Cardiol. 2019; 2019:6945372. PMC: 6739786. DOI: 10.1155/2019/6945372. View

13.

Ryan T, Faxon D, GUNNAR R, Kennedy J, King 3rd S, Loop F . Guidelines for percutaneous transluminal coronary angioplasty. A report of the American College of Cardiology/American Heart Association Task Force on Assessment of Diagnostic and Therapeutic Cardiovascular Procedures (Subcommittee on Percutaneous.... Circulation. 1988; 78(2):486-502. DOI: 10.1161/01.cir.78.2.486. View

14.

Sawano M, Yamaji K, Kohsaka S, Inohara T, Numasawa Y, Ando H . Contemporary use and trends in percutaneous coronary intervention in Japan: an outline of the J-PCI registry. Cardiovasc Interv Ther. 2020; 35(3):218-226. PMC: 7295726. DOI: 10.1007/s12928-020-00669-z. View

15.

Sonoda S, Hibi K, Okura H, Fujii K, Node K, Kobayashi Y . Current clinical use of intravascular ultrasound imaging to guide percutaneous coronary interventions (update). Cardiovasc Interv Ther. 2022; 38(1):1-7. DOI: 10.1007/s12928-022-00892-w. View

16.

Saito Y, Kobayashi Y, Fujii K, Sonoda S, Tsujita K, Hibi K . CVIT 2023 clinical expert consensus document on intravascular ultrasound. Cardiovasc Interv Ther. 2023; 39(1):1-14. PMC: 10764584. DOI: 10.1007/s12928-023-00957-4. View

17.

Garcia-Garcia H, McFadden E, Farb A, Mehran R, Stone G, Spertus J . Standardized End Point Definitions for Coronary Intervention Trials: The Academic Research Consortium-2 Consensus Document. Circulation. 2018; 137(24):2635-2650. DOI: 10.1161/CIRCULATIONAHA.117.029289. View

18.

Rogers J, Lasala J . Coronary artery dissection and perforation complicating percutaneous coronary intervention. J Invasive Cardiol. 2004; 16(9):493-9. View

19.

Huber M, Mooney J, Madison J, Mooney M . Use of a morphologic classification to predict clinical outcome after dissection from coronary angioplasty. Am J Cardiol. 1991; 68(5):467-71. DOI: 10.1016/0002-9149(91)90780-o. View

20.

Eshtehardi P, Adorjan P, Togni M, Tevaearai H, Vogel R, Seiler C . Iatrogenic left main coronary artery dissection: incidence, classification, management, and long-term follow-up. Am Heart J. 2010; 159(6):1147-53. DOI: 10.1016/j.ahj.2010.03.012. View