Sequential techniques of provisional stenting in coronary bifurcation with the Xposition S™ self-apposing nitinol stent. A comparative bench study - 25/12/18
Résumé |
Background |
Coronary bifurcation revascularization needs to take account of the systematic diameter differential between vessels based on fractal geometry, and to limit side-branch obstruction (SBO). The mechanical properties of the Xposition S™ self-apposing stent seem interesting for provisional stenting of coronary bifurcations.
Objectives |
The aim of this experimental fractal bifurcation bench study was to determine the best sequential provisional stenting technique with the Xposition S™ self-apposing nitinol stent (STENTYS, France).
Methods |
A fractal bifurcation bench test compared three Xposition S™ provisional stenting strategies: implantation alone, side-branch inflation (SBI) alone, and complete rePOT [initial proximal optimization technique (POT)+SBI+final POT]. Two dimensional- and 3D-OCT analyses and micro-scanner were performed to quantify the main mechanical results at each step.
Results |
Of the 3 groups (n=5 each), SBI alone and complete rePOT provided better mechanical results than implantation alone for residual SBO (respectively, 24.6±5.6% and 24.8±5.0% vs. 46.5±10.3%, P<0.05) and for malapposition (respectively, 0.9±0.6% and 0.8±0.4% vs. 3.8±1.9%, P<0.05). Unlike SBI, the POTs did not improve the final rePOT result. SBI, alone or during rePOT, systematically led to only one connector disconnection, whereas implantation alone maintained stent integrity (P>0.05) (Fig. 1).
Conclusions |
This experimental study justifies systematic SBI in clinical practice during provisional stenting with Xposition STM, but not post-dilatation specifically dedicated to bifurcation stenting (i.e., the two POTs in the rePOT sequence). However, global post-dilatation after implantation is still mandatory with Xposition STM stents, to prevent stent under-expansion due to untreated stenosis.
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Vol 11 - N° 1
P. 25 - janvier 2019 Retour au numéroBienvenue sur EM-consulte, la référence des professionnels de santé.
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