longitudinal stent compression€¦ · strategy •medina type 0,1,1 lesion •reverse t-stenting...
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Longitudinal stent compression predisposing mechanical properties, incidence and predictors
Gregor Leibundgut, MD
Scientific Meeting of the European Bifurcation Club
Barcelona 2012
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Medina)0,1,1)Lesion)
CRA)38,)LAO)2
Medina 0,1,1 Lesion
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Strategy • Medina type 0,1,1 lesion
• Reverse T-stenting
• Proximal Optimization Technique (POT)
• Crush technique
• Final kissing We considered a 2-stent strategy because the SB is important and heavily diseased.
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Main Branch (LAD) Stenting
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Side Branch (RD1) Stenting
Text
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Side Branch (RD1) Stenting II
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After 2nd Stent Placement After Longitudinal Compression
Optical Coherence Tomography (OCT)
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Complication Management Complica. on)Management
post)dilata. on
kissing)balloon final)result
2nd)stent)placement
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Final Result Final)Result
RAO)cranial LAO)cranial spider)view
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Procedure Summary
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Scaffold Designs
Stent Alloy Strut thickness (μm) Longitudinal connections Strut orientation
Promus Element PtCr 81 2 diagonal, linear
Taxus Liberté SS 97 3x2 diagonal, curved
Cypher Select SS 140 6 vertical, double-curved
Resolute Integrity CoCr 91 2/3 point, welded
Xience Prime CoCr 81 3 vertical, single-curved
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unpublished data
Compressibility by Design
35% 39% 15%
30% 18%
Cypher Element Integrity Taxus Liberté Xience Prime
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Leibundgut G, Gick M et al. CCI 2012
Bench Testing Apparatus
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Leibundgut G, Gick M et al. CCI 2012
Longitudinal Stability
Strain Hardening Necking
Fracture Point
Ultimate Strength
Strain
Forc
e
Yield Strength
idealized force-strain curve
coronary stent
typical force-strain curve of a solid body
elastic deformation without structural
damage (spring)
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Leibundgut G, Gick M et al. CCI 2012
Bench Testing
0 1 2 3 4 5 6
CypherSelect
Strain(mm)
0 1 2 3 4 5 6
TaxusLiberté
Strain(mm)
0
0.3
0.7
1.0
1.3
0 1 2 3 4 5 6
PromusElement
Force(N)
Strain(mm)
0
0.3
0.7
1.0
1.3
0 1 2 3 4 5 6
PromusElement
Force(N)
Strain(mm)
0 1 2 3 4 5 6
XiencePrime
Strain(mm)
0 1 2 3 4 5 6
ResoluteIntegrity
Strain(mm)
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unpublished data
Elastic Range
0
0.2
0.4
0.6
0.8
1.0
1.2
PromusElement XiencePrime ResoluteIntegrity TaxusLiberté CypherSelect
0.892
0.1800.1670.3850.049
SpringConstantN/m
m0.015 <0.0001ns ns
(S ffn
e
ss)
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Leibundgut G, Gick M et al. CCI 2012
Mechanical Properties
0
0.2
0.4
0.6
0.8
1.0
1.2
PromusElement XiencePrime ResoluteIntegrity TaxusLiberté CypherSelect
0.851
0.3850.5200.668
0.149
UltimateStrength
Force(N)
<0.0001 <0.00010.0002 <0.0001
0.2N
0
0.1
0.3
0.4
0.5
0.7
0.8
PromusElement XiencePrime ResoluteIntegrity TaxusLiberté CypherSelect
0.610
0.3510.2830.401
0.108
YieldForceForce(N)
0.0001 <0.00010.001 0.007
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Leibundgut G, Gick M et al. CCI 2012
Frequency
• January 1, 2010 to October 31, 2011
• 2,936 Promus Element stents in 1,295 patients
• Longitudinal stent compression in 20 PCI cases
• 1.44% of PCI cases
• 0.70% of all lesions
• 0.68% of all PES
• Longitudinal stent compression complicates procedure and necessitates additional stent placement
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Leibundgut G, Gick M et al. CCI 2012
Predictors | Patient Characteristics
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Leibundgut G, Gick M et al. CCI 2012
Predictors | Lesion Characteristics
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THANK YOU