Romaguera Rafael, Roura Gerard, Gomez-Lara Josep, Ferreiro Jose L, Gracida Montserrat, Teruel Luis, de Albert Matias, Ariza Albert, Gomez-Hospital Joan A, Cequier Angel
Hospital Universitari de Bellvitge, Heart Diseases Institute, Feixa Llarga s/n, Barcelona, 08907, Spain.
J Invasive Cardiol. 2014 Apr;26(4):161-6.
Some modifications introduced in the design of the new generation of drug-eluting stent (DES) to improve their flexibility may entail a reduction in their longitudinal strength. This study sought to evaluate the longitudinal deformation of DESs by multislice computed tomography (MSCT).
This study included DESs that could have been potentially deformed by mechanical actions such as: (1) catheter impingement; (2) postdilation; (3) kissing balloon; and (4) intravascular imaging after implantation. Patients on atrial fibrillation or with overlapping stents were excluded. All patients underwent stent length evaluation by MSCT 9-12 months after implantation.
Forty-five stents were included: 15 platinum chromium (PtCr-DES), 15 cobalt chromium (CoCr-DES), and 15 stainless-steel (SS-DES). The relative longitudinal deformation by stent type was 6.93 ± 5.82% for PtCr-DES, 6.19 ± 5.79% for CoCr- DES, and 4.03 ± 4.07% for SS-DES (P=.31). Among the mechanical actions studied, only catheter impingement was related to longitudinal stent deformation (P<.01). After adjustment, only catheter impingement (P<.01) and nominal stent length (P=.049) were independently related to longitudinal deformation. There were no stent fractures.
Longitudinal deformation of DESs is common in all the studied platforms when subject to longitudinal forces. Guiding catheter impingement is the only mechanical action significantly associated with DES shortening.
新一代药物洗脱支架（DES）设计中引入的一些旨在提高其柔韧性的改进措施可能会导致其纵向强度降低。本研究旨在通过多层计算机断层扫描（MSCT）评估DES的纵向变形情况。
本研究纳入了可能因以下机械作用而发生潜在变形的DES：（1）导管碰撞；（2）后扩张；（3）双球囊对吻扩张；（4）植入后血管内成像。排除患有心房颤动或支架重叠的患者。所有患者在植入后9至12个月通过MSCT进行支架长度评估。
共纳入45个支架：15个铂铬合金支架（PtCr-DES）、15个钴铬合金支架（CoCr-DES）和15个不锈钢支架（SS-DES）。PtCr-DES的相对纵向变形为6.93±5.82%，CoCr-DES为6.19±5.79%，SS-DES为4.03±4.07%（P = 0.31）。在所研究的机械作用中，只有导管碰撞与支架纵向变形有关（P < 0.01）。调整后，只有导管碰撞（P < 0.01）和标称支架长度（P = 0.049）与纵向变形独立相关。未发生支架断裂。
当受到纵向力作用时，DES的纵向变形在所有研究平台中都很常见。引导导管碰撞是与DES缩短显著相关的唯一机械作用。
