Which DES is the most appropriate for very small target vessels? Experimental study of stent expandable performance with
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ORIGINAL ARTICLE
Which DES is the most appropriate for very small target vessels? Experimental study of stent expandable performance with SES, PES, ZES and EES Yuki Horita • Masanobu Namura • Masatoshi Ikeda Taketoshi Tsuchiya • Hidenobu Terai • Ryota Fukuoka • Naoto Tama • Toshimitsu Takagi
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Received: 19 August 2010 / Accepted: 4 January 2011 / Published online: 18 February 2011 Ó Japanese Association of Cardiovascular Intervention and Therapeutics 2011
Abstract The restenosis rate of coronary stent has significantly decreased by implantation of the drug-eluting stent (DES). We often experienced the DES implantation for very small target vessels. The minimum size of DES in Japan and USA is 2.5 mm-diameter, but there were no reports of the expandability of DESs for the very small target vessels with reference diameter \2.2 mm. We clarify the expandable performance of 2.5 mm-DESs for very small target vessels with reference diameter \2.2 mm in vitro and vivo study. We studied 3 pieces in each kind of DES (Sirolimus-eluting stent; SES, Paclitaxel-eluting stent; PES, Zotarolimus-eluting stent; ZES and Everolimuseluting stent; EES) in vitro and vivo study of the porcine coronary artery with reference diameter \2.2 mm. By using the delivery balloon, each stent was initially dilated with 3.5 atm. And the pressure of 0.5 atm. was applied until it reached the maximum pressure of 12 atm. The minimum pressure of the full expanded stent balloon was estimated as the minimum expandable pressure. The stentinner diameter and area on each pressure were measured by IVUS. The average minimum expandable pressure (atm.) in vitro/vivo was 4.7/4.5 in SES, 7.2/6.8 in PES, 4.3/4.5 in ZES and 3.8/3.8 in EES. The inner diameter (mm) in vitro/ vivo at minimum expandable pressure was 1.81 ± 0.07/ 1.84 ± 0.05 in SES, 2.31 ± 0.10/2.13 ± 0.13 in PES, 2.41 ± 0.13/1.98 ± 0.31 in ZES and 2.13 ± 0.11/ 1.88 ± 0.22 in EES. The stent inner-diameter (mm) of DESs at 8 atm. in vivo was 2.16/2.21/2.45/2.25 in SES/ PES/ZES/EES. All kinds of DES could be delivered to very
Y. Horita (&) M. Namura M. Ikeda T. Tsuchiya H. Terai R. Fukuoka N. Tama T. Takagi Department of Cardiology, Kanazawa Cardiovascular Hospital, 16-Ha, Tanakamachi, Kanazawa 920-0007, Japan e-mail: [email protected]
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small target vessels with reference diameter \2.2 mm at the minimum expandable pressure in vivo study, but the stent which presented adequate stent inner-diameter at 8 atm. was only SES. We have to implant the 2.5 mmDESs for very small target vessels according to the data based on this expandability of DESs to bail out threatening occlusion due to coronary dissection or elastic recoil. Keywords Very small target vessels Expandability of DES Minimum expandable pressure 2.5 mm-sized DES
Introduction The implantation of bare-metal coronary stent (BMS) have reduced the rate of restenosis and major adverse cardiac events in comparison with balloon angioplasty, and effective procedure in treating acute vessel closure due to balloon-induced coron
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