From the Department of Cardiology, Hospital General Universitario
Gregorio Marañón, Universidad Complutense de Madrid, Spain.
Correspondence to Javier Botas, MD, Laboratorio de Hemodinámica, Departamento de Cardiología, Hospital General Universitario Gregorio Marañón, Dr Esquerdo 46, 28007 Madrid, Spain. E-mail javbotas{at}jet.es
Background—Intravascular ultrasound
(IVUS) studies have demonstrated that stents are frequently
suboptimally expanded despite the use of high pressures for deployment.
The purpose of this study was to identify the mechanisms responsible
for such residual lumen stenosis.
Methods and Results—Fifty-seven lesions from 50 patients treated
with high-pressure (median±interquartile range, 14±2 atm) elective
(44 de novo, 13 restenotic lesions) stenting were prospectively
studied (29 Wiktor, Medtronic; 28 Palmaz-Schatz, Cordis Corp). Balloon
subexpansion was calculated as the difference between maximal and
minimal balloon cross-sectional areas at peak pressure measured by
automatic edge detection; elastic recoil was calculated as the
difference between minimal measured balloon size and IVUS-derived
minimal lumen area within the stent. Angiographic residual diameter
stenosis was 10±13% (reference diameter, 3.1±0.7 mm;
balloon to artery ratio, 1.12±0.23) and IVUS-derived stent expansion
was 80±28%. However, although balloon nominal size was 9.6±1.3
mm2 and maximal balloon size measured inside the
coronary lumen was 12.5±3.2 mm2, final stent
minimal lumen area was only 7.1±2.2 mm2. Balloon
subexpansion of 4.0±1.8 mm2 (33%) and elastic recoil
of 1.6±2.3 mm2 (20%) (both P<0.0001)
were the two mechanisms responsible for residual luminal
stenosis. Wiktor stent and peak inflation pressure correlated
with balloon subexpansion, whereas Wiktor stent, de novo lesion, and
minimal lumen area at baseline correlated with elastic recoil.
Conclusions—Despite high-pressure deployment, lumen dimensions
after stenting are only 57% of maximal achievable. Inadequate balloon
expansion and elastic recoil are responsible for residual lumen
stenosis, suggesting that plaque characteristics and stent
resistance deserve further investigation.
© 1998 American Heart Association, Inc.
Clinical Investigation and Reports
Mechanisms of Residual Lumen Stenosis After High-Pressure Stent Implantation
A Quantitative Coronary Angiography and Intravascular Ultrasound Study
Key Words: stents • ultrasonics • revascularization • angioplasty • balloon
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