Prevalence and anatomical factors associated with stent under-expansion in non-severely calcified lesions.
Catheter Cardiovasc Interv
; 103(6): 833-842, 2024 May.
Article
en En
| MEDLINE
| ID: mdl-38639137
ABSTRACT
BACKGROUND:
Stent underexpansion, typically related to lesion calcification, is the strongest predictor of adverse events after percutaneous coronary intervention (PCI). Although uncommon, underexpansion may also occur in non-severely calcified lesions.AIM:
We sought to identify the prevalence and anatomical characteristics of underexpansion in non-severely calcified lesions.METHODS:
We included 993 patients who underwent optical coherence tomography-guided PCI of 1051 de novo lesions with maximum calcium arc <180°. Negative remodeling (NR) was the smallest lesion site external elastic lamina diameter that was also smaller than the distal reference. Stent expansion was evaluated using a linear regression model accounting for vessel tapering; underexpansion required both stent expansion <70% and stent area <4.5mm2.RESULTS:
Underexpansion was observed in 3.6% of non-heavily calcified lesions (38/1051). Pre-stent maximum calcium arc and thickness were greater in lesions with versus without underexpansion (median 119° vs. 85°, p = 0.002; median 0.95 mm vs. 0.78 mm, p = 0.008). NR was also more common in lesions with underexpansion (44.7% vs. 24.5%, p = 0.007). In the multivariable logistic regression model, larger and thicker eccentric calcium, mid left anterior descending artery (LAD) location, and NR were associated with underexpansion in non-severely calcified lesions. The rate of underexpansion was especially high (30.7%) in lesions exhibiting all three morphologies. Two-year TLF tended to be higher in underexpanded versus non-underexpanded stents (9.7% vs. 3.7%, unadjusted hazard ratio [95% confidence interval] = 3.02 [0.92, 9.58], p = 0.06).CONCLUSION:
Although underexpansion in the absence of severe calcium (<180°) is uncommon, mid-LAD lesions with NR and large and thick eccentric calcium were associated with underexpansion.Palabras clave
Texto completo:
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Base de datos:
MEDLINE
Asunto principal:
Enfermedad de la Arteria Coronaria
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Stents
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Vasos Coronarios
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Tomografía de Coherencia Óptica
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Calcificación Vascular
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Intervención Coronaria Percutánea
Idioma:
En
Revista:
Catheter Cardiovasc Interv
Asunto de la revista:
CARDIOLOGIA
Año:
2024
Tipo del documento:
Article