Radiopacity of Coronary Stents, an In Vitro Comparative Study
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Cardiovascular Engineering and Technology (Ó 2020) https://doi.org/10.1007/s13239-020-00492-w
Original Article
Radiopacity of Coronary Stents, an In Vitro Comparative Study PIERRE-GUILLAUME PIRIOU ,1,4 PATRICE GUE´RIN,1,2 MICKAEL BONIN,1 JULIEN PLESSIS,1 VINCENT LETOCART,1 THIBAUT MANIGOLD,1 BE´ATRICE GUY,3 and FABIENNE JORDANA2 1 Department of Cardiology, Nantes University Hospital, Nantes, France; 2INSERM Unit 1229, Regenerative Medicine and Skeleton, Nantes, France; 3Nantes School of Medicine, Nantes, France; and 4Service de Cardiologie, CHU de Nantes-Hoˆpital Nord Lae¨nnec, Boulevard Professeur Jacques Monod, 44093 Nantes Cedex 1, France
(Received 10 May 2020; accepted 24 September 2020) Associate Editor Gautam Kumar oversaw the review of this article.
Abstract Purpose—Interventional cardiology devices and especially stents are constantly evolving. A good radiopacity is essential to properly position the stent and to reduce the risk of complications during percutaneous coronary intervention (PCI). We wanted to assess the radiopacity of coronary stents. Methods—9 stents were evaluated. Stents were deployed in a silicon bifurcation model and several pulsed fluoroscopy acquisitions (7.5 and 15 pulses/s) of each device were performed in a catheterization laboratory. Quantitative radiopacity assessment was performed using a radiopacity visual scale and qualitative radiopacity assessment was performed by showing the images to three experienced operators, single-blind. Results—Our study showed statistically significant differences between stents regarding radiopacity assessed in a quantitative analysis (p < 0.000001) or a qualitative analysis (p < 0.000001), whether the acquisitions were made in 7.5 or 15 pulses/s. Resolute Onyx and Synergy were the most radioopaque in both qualitative and qualitative analysis. Moreover, there was a statistically significant correlation between the radiopacity of stents, their strut thickness (p < 0.0001) and the presence of platinum in their metallic alloy (p < 0.0001). Conclusion—This study highlighted significant differences in the radiopacity of coronary stents deployed in a bench test model. The strut thickness and the presence of platinum increased the radiopacity. Keywords—Radiopacity, Coronary stent, Strut thickness, Fluoroscopy.
INTRODUCTION Interventional cardiology devices and especially stents are constantly evolving and so are angioplasty techniques. The stents have many physical and biomechanical characteristics, very different from each other, as it was demonstrated by Bonin et al.1 and no single prosthesis is ideal for all situations. Radiopacity is an important criterion to be taken into account when performing percutaneous coronary intervention (PCI), although it is not the only one. A good visualization of the stent is crucial for its proper positioning, which improves the safety of the procedure. For example, to avoid overlapping when two joined stents are implanted. This feature is particularly useful for complex angioplasties and for situations where it is more d
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