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Comparative performance of contemporary stents in 3D-printed left main bifurcation simulation models
Session:
Comunicações Orais - Sessão 06 - Intervenção coronária
Speaker:
Catarina Oliveira
Congress:
CPC 2023
Topic:
H. Interventional Cardiology and Cardiovascular Surgery
Theme:
25. Interventional Cardiology
Subtheme:
25.2 Coronary Intervention
Session Type:
Comunicações Orais
FP Number:
---
Authors:
Catarina Simões De Oliveira; Tiago Rodrigues; Joana Brito; Pedro Alves Silva; Beatriz Valente Silva; Beatriz Garcia; Ana Margarida Martins; Ana Abrantes; Miguel Raposo; Catarina Gregório; Daniel Cazeiro; Daniela Ricardo; Helena Santiago; Fausto J. Pinto; João Silva Marques
Abstract
<p style="text-align:justify"><span style="font-size:12pt"><span style="font-family:Calibri,sans-serif"><strong>Background:</strong> Interventions in left anterior descending artery (LAD) ostial lesions remain defiant. A left main (LM)-to-LAD cross-over stenting provides favorable outcomes but challenges current devices. There is need for comparative independent data on the performance of currently available stents. In clinical practice, wide anatomical variation impairs such studies. However, 3D-printing allows accurate anatomical reproduction that can be used in simulation testing. </span></span></p> <p style="text-align:justify"><span style="font-size:12pt"><span style="font-family:Calibri,sans-serif"><strong>Aim: </strong>To assess stent performance in 3D-printed diseased LM bifurcation model (Medina 0,1,0) using a realistic simulation environment.</span></span></p> <p style="text-align:justify"><span style="font-size:12pt"><span style="font-family:Calibri,sans-serif"><strong>Methods: </strong> A standard realistic LM anatomy with an eccentric ostial LAD lesion was replicated using 3D-printing. Tests were performed on a realistic pulsatile flow simulator in the cath lab. Five 3.5mmx18-21mm stents (Xience, Onyx, Synergy, Megatron and Ultimaster) were implanted in 3D-printed models using a standardized protocol (Figure a) that included proximal optimization technique (POT). Angiographic and OCT runs were acquired at each procedural step and images were blindly reviewed and analyzed offline. We report descriptive and comparative data of stent platform performance with a focus on stent placement accuracy, longitudinal deformation, overexpansion ability and radial strength. </span></span></p> <p style="text-align:justify"><span style="font-size:12pt"><span style="font-family:Calibri,sans-serif"><strong>Results</strong>:In total, 5 test procedures were performed and a total of 15 OCT runs and 20 angiographic images were reviewed. Stent placement accuracy, defined as balloon marks to stent distance in angio was highest with Xience (0.27mm) and lowest with Synergy (1.01mm). Proximal overexpansion ability after sequential 5mm and 6mm POT was also highest with Xience (stent area 26.99mm<sup>2</sup>) and lowest with Synergy (stent area 15.58mm<sup>2</sup>). Regarding longitudinal deformation, OCT analysis revealed shortening of Onyx (-0.1 mm), Megatron (-0.4mm) and Ultimaster (-0.7 mm) stents and elongation of Synergy (1.4 mm) and Xience (+3.8 mm) after POT. In angio, there was elongation of Xience (+3.5 mm) and shortening of all other stents (-0.9mm to -3.5mm). Radial strength was highest with Onyx (MLA 4.99mm<sup>2</sup>) and lowest with Synergy (4.12mm<sup>2</sup>). Considering eccentricity, Ultimaster achieved the lowest (0.92) and Onyx the highest (0.84). High pressure balloon inflation increased MLA in all stents except Synergy and Xience (Figure b). POT negatively impacted stent performance at the LAD ostial lesion in two of the stents that showed recoil. There was no significant correlation of proximal stent expansion and stent strut thickness (r 0.296; p=0.629).</span></span></p> <p><strong><span style="font-size:12.0pt"><span style="font-family:"Calibri",sans-serif">Conclusion</span></span></strong><span style="font-size:12.0pt"><span style="font-family:"Calibri",sans-serif">: In this study of percutaneous coronary intervention in 3D-printed realistic models of left main bifurcation coronary artery disease we have shown that stent performance is not uniform among available stents. Knowledge of strengths and weaknesses of each individual stent allows a tailored approach to bifurcation stenting in order to anticipate and optimize results.</span></span></p>
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