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Observational Study
. 2025 Mar;105(4):870-877.
doi: 10.1002/ccd.31404. Epub 2025 Jan 8.

Contemporary Use of Post-Dilatation for Stent Optimization During Percutaneous Coronary Intervention; Results From the Netherlands Heart Registration

Affiliations
Observational Study

Contemporary Use of Post-Dilatation for Stent Optimization During Percutaneous Coronary Intervention; Results From the Netherlands Heart Registration

K A J van Beek et al. Catheter Cardiovasc Interv. 2025 Mar.

Abstract

Backgrounds: Post-dilatation after stenting with a non-compliant (NC) balloon can be used to improve overall percutaneous coronary intervention (PCI) result. Due to lack of evidence on the effect of post-dilatation on adverse clinical endpoints there is no consensus whether post-dilatation should be used routinely. The aim of the current study was to determine the contemporary practice of post-dilatation.

Methods: This study included patients from the Netherlands Heart Registration who underwent PCI between the 4th quarter of 2020 and the 3rd quarter of 2021. The primary endpoint was the rate of post-dilatation with a NC balloon. Secondary endpoints included differences in baseline and procedural characteristics of patients that received post-dilatation and patients that did not receive post-dilatation.

Results: Out of 12,960 patients from 11 hospitals, 49.9% underwent post-dilatation. There was a variety in post-dilatation between hospitals ranging from 29.3% to 82.7% and among operators ranging from 15.9% to 90.5%. Post-dilatation was used less frequent in patients presenting with ST-elevation myocardial infarction or out of hospital cardiac arrest. Multivessel and left main PCI, long stent length and use of intracoronary imaging and calcium modification were associated with increased use of post-dilatation. When imaging was used, the percentage of post-dilatation was 79.4%.

Conclusions: In the Netherlands, stent optimization with post-dilatation using NC balloon is performed in only half of the patients undergoing PCI, with variations in frequency across centres and operators. Post-dilatation is more often used in cases of complex PCI and when intracoronary imaging or calcium modification techniques are used.

Keywords: percutaneous coronary intervention; post‐dilatation; stent optimalization.

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Conflict of interest statement

The authors declare no conflicts of interest.

Figures

Figure 1
Figure 1
This study includes 12,690 patients from 12 PCI centers. Overall post‐dilatation was used in 49.9% of the patients. There was a variation in use of post‐dilatation among centers ranging from 29.3% to 82.7% (panel A) and among operators ranging from 15.9% to 90.5% (panel B). [Color figure can be viewed at wileyonlinelibrary.com]
Figure 2
Figure 2
Sizing of the non‐compliant balloon relative to the stent. The non‐compliant balloon most frequently sized 0.5 mm larger than the stent diameter (50.6%). AL‐IM, indicates anterolateral/intermediate branch; LAD, left anterior descending; LM, left main; RCA, right coronary artery; RCX, ramus circumflexus. [Color figure can be viewed at wileyonlinelibrary.com]
Figure 3
Figure 3
Use of post‐dilatation per coronary vessel (panel A) and in case of IVUS, OCT and calcium modification therapy (panel B). Overall cohort rate was 49.9%. AL‐IM, indicates anterolateral/intermediate branch; IVUS, intravascular ultrasound; LAD, left anterior descending; LM, left main; OCT, optimal coherence tomography; RCA, right coronary artery; RCX, ramus circumflexus. [Color figure can be viewed at wileyonlinelibrary.com]

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