Tissue Stresses in Stented Coronary Arteries with Different Geometries: Effect of the Relation Between Stent Length and Lesion Length

Abstract Background Stent manufacturers always record stent shortening data while they do not record stent elongation data. The aim of this study is to identify both stent shortening and elongation occurring after deployment in the coronary arteries and know their percentage. Results The length of coronary stents was measured by intravascular ultrasound (IVUS) by (1) edge-to-edge (E-E) length, measured from the appearance of the first distal strut to the last proximal strut, and (2) area-to-area (A-A) length, measured from the first distal struts seen at more than one IVUS quadrant to the last proximal struts seen at more than one IVUS quadrant. Stent shortening was defined as both E-E and A-A lengths were shorter than the manufacturer box-stated length (shortened group). Stent elongation was defined as both E-E and A-A lengths were longer than the manufacturer box-stated length (elongated group), otherwise unchanged group. Consecutive 102 stents deployed in ischemic patients were included. Stent elongation was detected in 67.6% (69 stents), and shortening was detected in 15.7% (16 stents), while unchanged stents were detected in 16.7% (17 stents). Although the 3 groups had similar box-stated length and predicted foreshortened length, they had significantly different measurements by IVUS, p<0.001 for each comparison. Differences from box-stated length were 1.9±1.4mm, −1.4±0.4mm, and 0.4±0.3mm, respectively, p<0.001. The elongated group had significantly longer differences from the corresponding box-stated and predicted foreshortened lengths, while the shortened group had significantly shorter differences from the corresponding box-stated length and similar foreshortened length. By multinomial regression analysis, the plaque-media area and stent deployment pressure were the independent predictors of the stent length groups, p=0.015 and p=0.026, respectively. Conclusions Change in stent length is not only shortening—as mentioned in the manufacturer documents—but also stent elongation. Stent elongation is dominant, and the most important predictors of longitudinal stent changes are plaque-media area and stent deployment pressure.

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PTA and Stenting of Femoropopliteal Trunk With Cordis Smartflex Stent System: A Single-Center Experience

Vascular and Endovascular Surgery ◽

10.1177/1538574419875551 ◽

2019 ◽

Vol 54 (1) ◽

pp. 17-24 ◽

Cited By ~ 1

Author(s):

Luca Garriboli ◽

Tommaso Miccoli ◽

Gianguido Pruner ◽

Antonio Maria Jannello

Keyword(s):

Limb Ischemia ◽

Primary Patency ◽

Lesion Length ◽

Acute Limb Ischemia ◽

Vascular Stent ◽

Stent Patency ◽

Stent Occlusion ◽

End Points ◽

Stent System ◽

Stent Length

Introduction: The aim of this study is to describe our experience in the treatment of femoropopliteal occlusive disease with percutaneous transluminal angioplasty (PTA) followed by stenting with S.M.A.R.T. Flex vascular stent system. Materials and Methods: From June 2014 to October 2018, 80 patients were treated at our Institution for intermittent claudication, critical, or acute limb ischemia due to total occlusion or long diffused lesions of the femoropopliteal segment. Main study end points are primary patency, target lesion revascularization, and stent fractures; secondary end points are major amputation rate, procedure-related bleeding, incidence of intrastent restenosis, and primary assisted patency after reintervention. Results: Mean follow-up time was 21 months (range 2-48 months). Primary patency rate was 80% (64 patients of 80), with mean covered lesion length of 8.2 cm. The deployment of a single stent was obtained for 57 (89%) patients, with a mean stent length of 9.86 cm. Of 80 patients, 2 (2.5%) had early stent occlusion within first 48 hours after the procedure, while 4 (5%) of 80 patients experienced stent occlusion within first 6 months. Of 80 patients, 6 (7.5%) had an intrastent restenosis detected at duplex ultrasound with a primary-assisted patency after simple re-PTA procedures of 83.3% at 12 months. Discussion: In the literature, primary patency after PTA and stenting of the femoropopliteal trunk seems to be related to several variables, such as number of stents used, specific stent length, diameters, type and length of lesions, type of pathology (if acute or chronic), and number of preoperatory patent below-the-knee vessels. In this study, we try to analyze each single factor in order to understand their role in predisposing specific stent restenosis. Conclusions: S.M.A.R.T. Flex vascular stent system has shown good results in terms of primary patency in the treatment of calcified lesions both at SFA and at popliteal level. However, in our experience, stent patency seems to be significantly poorer in patients presenting with acute limb ischemia associated with chronic atherosclerotic disease as well as for lesions located in the mid-distal part of the popliteal artery and both when number of stents increases or number of runoff vessel decreases.

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Long-term results of the heparin-bonded Viabahn stent graft in femoropopliteal TASC C and D lesions with a covered stent length of minimum 25 cm

Vascular ◽

10.1177/1708538119840863 ◽

2019 ◽

Vol 27 (5) ◽

pp. 553-559 ◽

Cited By ~ 2

Author(s):

C Uhl ◽

A Dadras ◽

F Reichmann ◽

T Betz ◽

N Zorger ◽

...

Keyword(s):

Limb Salvage ◽

Stent Graft ◽

Covered Stent ◽

Long Term Results ◽

Lesion Length ◽

Secondary Patency ◽

Graft Occlusion ◽

Long Term Outcome ◽

Stent Length

Background Heparin-bonded covered stent grafts (Viabahn) are used to treat femoropopliteal long-segment arteriosclerotic lesions. The aim of this study was to evaluate the long-term outcome of Viabahn grafts with a covered stent length of minimum 25 cm. Methods We conducted a retrospective analysis of patients receiving a heparin-bonded stent graft in our clinic who met the length criteria between July 2010 and March 2018. Primary endpoints were patency rates, limb salvage and survival after five years. Secondary endpoint was the 30-day outcome including early complications. Results A total of 62 patients (45 male, median age 70.5 years) were included. The median arteriosclerotic lesion length was 25 cm (22.0–41.3 cm), the minimum covered stent length was 25 cm (25–46 cm). All lesions were TASC C and D lesions. The 30-day mortality was 0%, an early stent graft occlusion occurred in 8.1%. A major amputation was performed in 1.6%. Primary patency, primary assisted patency, secondary patency, limb salvage and survival were 38.5%, 45.7%, 52.4%, 92.8% and 68.9% after five years. Distal stent graft end below the femoral condyles and critical limb ischemia was associated with a significant decreased survival. The diameter of the stent had no influence on the outcome. Conclusion The Viabahn stent graft for long segment arteriosclerotic lesions is a feasible treatment with adequate long-term results.

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Influence of Stent Length to Lesion Length Ratio on Angiographic and Clinical Outcomes After Implantation of Bare Metal and Drug-Eluting Stents (the TAXUS-IV Study)

The American Journal of Cardiology ◽

10.1016/j.amjcard.2005.01.024 ◽

2005 ◽

Vol 95 (9) ◽

pp. 1043-1048 ◽

Cited By ~ 11

Author(s):

S. Chiu Wong ◽

Mun K. Hong ◽

Stephen G. Ellis ◽

Maurice Buchbinder ◽

Mark Reisman ◽

...

Keyword(s):

Clinical Outcomes ◽

Length Ratio ◽

Drug Eluting Stents ◽

Lesion Length ◽

Bare Metal ◽

Stent Length ◽

Drug Eluting

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The impact of precise robotic lesion length measurement on stent length selection: Ramifications for stent savings

Cardiovascular Revascularization Medicine ◽

10.1016/j.carrev.2015.06.005 ◽

2015 ◽

Vol 16 (6) ◽

pp. 348-350 ◽

Cited By ~ 14

Author(s):

Paul T. Campbell ◽

Kevin R. Kruse ◽

Christopher R. Kroll ◽

Janet Y. Patterson ◽

Michele J. Esposito

Keyword(s):

Length Measurement ◽

Lesion Length ◽

Stent Length ◽

The Impact

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In vivo measurement of stent length by using intravascular ultrasound

The Egyptian Heart Journal ◽

10.1186/s43044-019-0036-9 ◽

2019 ◽

Vol 71 (1) ◽

Author(s):

Magdy Algowhary ◽

Salma Taha ◽

Hosam Hasan-Ali ◽

Akihiko Matsumura

Keyword(s):

Intravascular Ultrasound ◽

Bare Metal Stent ◽

Edge Length ◽

Drug Eluting Stent ◽

Elastic Membrane ◽

Lesion Length ◽

In Vivo Measurement ◽

Longitudinal View ◽

Stent Length

Abstract Background What happens to stent length when deployed in a coronary artery? It is the aim of this study. Results Consecutive 95 balloon-expandable stents (BES) were studied by intravascular ultrasound (IVUS) imaging. The stent length was measured from the longitudinal view in two ways: (1) edge-to-edge length (E-E) measured between distal and proximal stent frames located at one IVUS quadrant and (2) area-to-area length (A-A) measured between distal and proximal stent frames located at two or more IVUS quadrants. IVUS measurements were compared with the manufacturer-stated length (M-L). The median E-E length was significantly longer than M-L, 18.76 mm [interquartile range (IQR) 15.65–23.60] versus 18.00 mm (IQR 15.00–23.00), respectively, p < 0.0001. Also, the median A-A length was significantly longer, 18.36 mm (IQR 15.19–23.47), p < 0.0001, than M-L. Moreover, the E-E length was significantly different from A-A length, p < 0.0001. Among the stent groups, the differences were significantly present in all drug-eluting stent and bare metal stent (BMS) comparisons, p < 0.0001, except the A-A length versus M-L in BMS only. By multivariate analysis, the predictors of difference in stent length were as follows: lesion length, p = 0.01; pre-intervention minimal diameter of the external elastic membrane (EEM), p = 0.03; lesions present in the left anterior descending branch, p = 0.03; and M-L, p = 0.04. Conclusions In the present study, the length of BES measured by IVUS was significantly different from the manufacturer-stated length. In addition to the manufacturer length, other important factors such as lesion length, pre-intervention diameter of EEM, and affected vessel determine the stent length.

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CORONARY ARTERY DISEASE (CAD);

The Professional Medical Journal ◽

10.29309/tpmj/2017.24.01.483 ◽

2017 ◽

Vol 24 (01) ◽

pp. 21-25

Author(s):

Naeem Asghar ◽

Liaqat Ali ◽

Asadullah -

Keyword(s):

Coronary Artery ◽

Coronary Arteries ◽

Coefficient Of Determination ◽

Lesion Length ◽

Fractional Flow ◽

Flow Reserve ◽

Inter Observer Variability ◽

Artery Disease ◽

The Cost ◽

The Relationship

Background: Coronary artery lesion severity is physiological assessed byfractional myocardial flow reserve (FFR). Angiographic assessment of intermediate severitylesions is problematic as inter-observer variability is significant. Hence one is not sure aboutthe hemodynamic or functional significance of these lesions. FFR is helpful in this situationby assessing functional or hemodynamic significance of these intermediate coronary lesions.An FFR value <0.80 identifies ischemia-causing coronary stenosis with an accuracy of >90%suggesting that intermediate coronary lesion is in fact functionally important. Objective: Todetermine the correlation between mean lesion length of diffuse intermediate stenosis (40%-70% stenosis) of proximal and mid segment of major coronary arteries and mean fractional flowreserve (FFR). Study duration: From 1-07-2015 to 31-12-2015. Study design: Cross sectionalstudy. Methodology: After approval from hospital Ethical committee and Informed consent, 60patients with intermediate diffuse lesions on coronary angiography from Faisalabad Institute ofCardiology were enrolled. FFR assessment of diffuse intermediate lesion was done by author.FFR assessment was done using FFR wire during maximal blood flow (hyperemia) whichwas induced by injecting bolus dose of intracoronary adenosine. The cost of procedure wasmanaged by hospital. Results: In this study, 28.33% (n=17) were between 20-50 years of age,mean+SD was calculated as 55.17+8.04 years, 51.67% (n=31) were male and 48.33% (n=29)were females. Correlation between mean lesion length of diffuse intermediate stenosis (40%-70% stenosis) of proximal and mid segment of major coronary arteries and mean fractionalflow reserve (FFR) was recorded it shows that mean lesion length was 24.53+4.78 mm whileFFR was recorded as 0.72+0.12, the value of R is -0.1928, technically a negative correlation,the relationship between variables is only weak (the nearer the value is to zero, the weakerthe relationship). The value of R2, the coefficient of determination, is 0.0372. Conclusion: Thecorrelation between mean lesion length of diffuse intermediate stenosis (40%-70% stenosis) ofproximal and mid segment of major coronary arteries and mean fractional flow reserve (FFR)was weak and did not suggest any hemodynamic significance of diffuse intermediate coronaryartery lesions.

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