Analysis of Longitudinal Stent Deformation by 3DStent Technology: An In Vitro Pilot Study.

BACKGROUND

Longitudinal stent deformation (LSD) is a classical pitfall of aorto-ostial percutaneous coronary intervention that carries out a higher risk for adverse outcomes when not corrected. This in vitro pilot study tested the performances of the new 3DStent (3DS) imaging mode (GE HealthCare) for the diagnosis of LSD.

METHODS

A total of 41 coronary stents (diameter: 3.0 mm; length: 21-32 mm) were implanted in silicone tubes. LSD was created in 21 samples by crushing the proximal stent edge with a guiding catheter tip, whereas the others were left undeformed. All samples were analyzed by angiography methods including 3DS. The data were analyzed twice by 3 independent reviewers blinded to the characteristics of the samples. The diagnosis was based on the assessment of the following: (1) increased radio-opacity in the proximal stent section; (2) loss of stent borders parallelism; (3) loss of stent cells symmetry in its proximal part; (4) decreased stent length; and (5) decreased internal area in proximal stent section.

RESULTS

A total of 246 reconstructions were analyzed. The 3DS overall performances for LSD diagnosis were good: the global sensitivity and specificity were respectively 98.9% and 100% (positive predictive value: 100%; negative predictive value: 99%). The interobserver and intraobserver variabilities (Cohen's k) ranged from k = 0.95 to k = 1.0 for the LSD diagnosis. The different individual item sensitivities ranged between 92% and 98% and their specificities between 99% and 100%.

CONCLUSIONS

The 3DS imaging technology appeared to be efficient in identifying LSD in vitro. Whether these results could be translated in vivo needs to be assessed.