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. 2017 Jan;32(1):12-17.
doi: 10.1007/s12928-016-0380-6. Epub 2016 Mar 11.

Reduction in incomplete stent apposition area caused by jailed struts after single stenting at left main bifurcation lesions: micro-CT analysis using a three-dimensional elastic bifurcated coronary artery model

Yutaka Hikichi  1   2 , Mitsuo Umezu  1   3 , Koichi Node  2 , Kiyotaka Iwasaki  4   5
Affiliations

Reduction in incomplete stent apposition area caused by jailed struts after single stenting at left main bifurcation lesions: micro-CT analysis using a three-dimensional elastic bifurcated coronary artery model

Yutaka Hikichi et al. Cardiovasc Interv Ther. 2017 Jan.

Abstract

Stent struts protruding into ostial side branch called "jailed strut" at bifurcation lesions is a likely cause of thrombus formation. We aimed to investigate the influences of multiple kissing balloon inflation (KBI) for stent expansion, and stent platform design, respectively, on the reduction of incomplete stent apposition area (ISA area) caused by jailed struts at a side-branch ostium, using a three-dimensional elastic left main (LM) bifurcated coronary artery model. The referenced LM bifurcation angle data of 209 patients were stratified by tertiles focusing on the angle between the LM trunk (LMT) and left anterior descending artery (LAD). A bifurcation model was fabricated with angles of 129°, 122.2°, and 76.4° for LMT-LAD, LMT-left circumflex (LCx), and LAD-LCx, respectively, and with diameters of 5, 3.75, and 3.5 mm for LMT, LAD, and LCx, respectively; these diameters fulfill Murray's law. A 75 % stenosis was included along the LMT. One-time and three-time KBIs were conducted using two-link Nobori and three-link Xience Xpedition (n = 6 each). The ISA area was quantified using micro-CT. Three-time KBI was effective in reducing the ISA area compared with one-time KBI for both the Nobori (p = 0.05) and Xience Xpedition (p = 0.07). The ISA area was smaller in the Nobori than in the Xience Xpedition, both in one-time and three-time KBI (one-time KBI: p = 0.003; three-time KBI: p = 0.001). Our findings of this study on reducing the ISA area by focusing on an interventional technique and stent design may help to improve coronary bifurcation intervention for a possibly better long-term clinical outcome.

Keywords: Incomplete stent apposition; Jailed strut; Left main bifurcation; Stent design; Stent expansion method.

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Conflict of interest statement

Compliance with ethical standards Human rights statement This study was approved by the ethics committee of Shin-Koga Hospital, and all patients provided written informed consent. Conflict of interest This study was supported by a Health Science Research Grant (H20–IKOU-IPAN-001) from the Ministry of Health, Labour and Welfare, Japan. All authors have no conflict of interest. Funding source Health Science Research Grant from Ministry of Health, Labour and Welfare, Japan.

Figures

Fig. 1
Fig. 1
Three-dimensional elastic left main bifurcated coronary artery model. a The dimensions of the left main bifurcation model. b The elastic left main bifurcation models employed in the bench test
Fig. 2
Fig. 2
Stent deployment procedures. a Stent deployment along LMT–LAD. b, c Proximal optimization technique. d Advancement of guidewire through a distal stent cell accessing the LCx. e Kissing balloon inflation
Fig. 3
Fig. 3
Micro-CT analysis of the incomplete stent apposition (ISA) area caused by jailed struts at the LCx ostium. a The two-link Nobori stent deployed in the bifurcation model. b The three-link Xience Xpedition stent deployed in the bifurcation model
Fig. 4
Fig. 4
Incomplete stent apposition areas detected by the micro-CT analysis. For each condition, six stents were tested
Fig. 5
Fig. 5
Effects of multiple kissing balloon inflation (KBI) and stent platform design on the incomplete stent apposition (ISA) area caused by jailed struts at the LCx ostium. a Comparison between one-time KBI and three-time KBI using the two-link Nobori stent. b Comparison between one-time KBI and three-time KBI using the three-link Xience Xpedition stent. c Comparison between the two-link Nobori stent and the three-link Xience Xpedition stent with one-time KBI. d Comparison between the two-link Nobori stent and the three-link Xience Xpedition stent with three-time KBI
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