Assessment of Stent Expansion after Direct Stenting Compared to Conventional Stenting
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- Category: Vol. 85, June 2017
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Assessment of Stent Expansion after Direct Stenting Compared to Conventional Stenting, MOHAMED LAIMOUD, YASSER NASSAR, WALID OMAR, AKRAM ABDELBARRY and HELMY ELGHAWABY
Abstract
Introduction: Stent underexpansion is a major risk factor for in-stent restenosis and acute in-stent thrombosis [1]. Direct coronary stenting has been shown to be safe and feasible, with a demonstrable reduction in cost, procedural time and radiation exposure [2].
Aim of Work: Comparison of direct stenting versus predi-latation and stenting regarding adequate stent expansion assessed by Intravascular Ultrasound (IVUS), Stentboost (SB) enhancement and Quantitative coronary angiography (QCA).
Methodology: Thirty three elective percutaneous coronary procedures and stenting were evaluated using IVUS, SB enhancement and QCA. We compared measurements of mean ±standard deviations of (Max SD, Min SD, Mean SD, stent symmetry index) after stent deployment. Balloon dilatation was done before stenting in 21 lesions while direct stenting was done in 12 lesions.
Results: The coronary lesions were class A (50% vs 14.29%, p0.04), class B 1/B2 (41.67% vs 47.61%, p0.23) and class C (8.33% vs 38.1%, p0.01) in the direct stenting and predilatation groups respectively. The Max SD was (3.46±0.45 vs 3.37±0.6, p0.67) by IVUS, and (3.44±0.30 vs 3.59±0.58, p0.32) by SB enhancement and (3.19±0.46 vs 3±0.46, p0.25) by QCA in direct stenting and predilatation groups respectively. The Min SD was (2.85±0.37 vs 2.72±0.6, p 0.46) by IVUS, (2.61±0.37 vs 2.52±0.47, p0.56) by SB enhancement and was (2.22±0.52 vs 1.88±0.38, p0.051) by QCA in direct stenting and predilatation groups respectively. The mean Max SD was (3.45±0.62 vs 3.55±0.56 vs 2.97±0.59) by IVUS vs SB sv QCA respectively. Max SD was significantly higher by IVUS vs QCA (p 0.009) and between SB vs QCA (p 0.001) while there was non significant difference between IVUS vs SB (p 0.53). The mean Min SD was (2.77±0.53 vs 2.58±0.56 vs 1.88±0.60) by IVUS vs SB vs QCA respectively. Min SD was significantly higher by IVUS vs QCA (p 0.001) and between SB vs QCA (p 0.001) while there was non significant difference between IVUS vs SB (p 0.07).
Conclusion: Direct stenting is associated with adequate stent expansion, compared to stenting after predilatation, as assessed with IVUS, SB enhancement. StentBoost enhancement has superior correlations for stent expansion measured by IVUS when compared with QCA.