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3DStent is a novel rotational angiography imaging capable of 3D reconstruction and measuring stent area and diameter, without need for intravascular imaging. To compare 3DStent and OCT-derived stent area and diameter after PCI. Patients with de novo coronary lesions who underwent treatment with a single DES and evaluated by OCT and 3DStent were included. Stent area and diameter were measured by 3DStent, at abluminal, mid and endoluminal side and by OCT. From September 2023 to February 2024 six coronary lesions were analyzed. Post-PCI stent area measured by OCT was (mean ± standard deviation) 7.03 ± 2.85 mm2 and by 3DStent 9.41 ± 2.79 mm2, 7.21 ± 2.23 mm2 and 5.63 ± 1.83 mm2 at abluminal, mid and endoluminal side, respectively. Stent diameter by OCT was 2.93 ± 0.58 mm, and by 3DStent 3.27 ± 0.50 mm, 2.86 ± 0.49 mm and 2.52 ± 0.45 mm at abluminal, mid and endoluminal side, respectively. Significant correlation was observed between OCT and 3DStent in relation to stent area (Exp(B) 3.35, mean of difference 0.19 ± 1.01 mm2, 95%CI -1.80–2.17 mm2, p < 0.001) and diameter (Exp(B) 3.18, mean difference − 0.07 ± 0.18 mm, 95%CI -0.43–0.30 mm, p < 0.001), particularly when 3DStent measurements performed at the mid side. Very high reproducibility was demonstrated by intra- and inter-observer analysis (r = 0.92 and r = 0.93 respectively). 3DStent appears to be an easy and reproducible tool to assess post-PCI stent area and diameter as compared to OCT. [ABSTRACT FROM AUTHOR]

Introduction: Acute carotid-related stroke (CRS), with its large thrombo-embolic load and large volume of affected brain tissue, poses significant management challenges. First generation (single-layer) carotid stents fail to insulate the athero-thrombotic material; thus they are often non-optimized (increasing thrombosis risk), yet their use is associated with a significant (20-30%) risk of new cerebral embolism. Aim: To evaluate, in a multi-center multi-specialty investigator-initiated study, outcomes of the MicroNET-covered (cell area ≈ 0.02-0.03 mm² ) carotid stent (CGuard, InspireMD) in consecutive CRS patients eligible for emergency recanalization. Treatment, other than study device use, was according to center/operator routine. Material and methods: Seventy-five patients (age 40-89 years, 26.7% women) were enrolled in 7 interventional stroke centers. Results: The median Alberta Stroke Program Early CT Score (ASPECTS) was 9 (6-10). Study stent use was 100% (no other stent types implanted); retrograde strategy predominated (69.2%) in tandem lesions. Technical success was 100%. Post-dilatation balloon diameter was 4.0 to 8.0 mm. 89% of patients achieved final modified Thrombolysis in Cerebral Infarction (mTICI) 2b-c/3. Glycoprotein IIb/IIIa inhibitor use as intraarterial (IA) bolus + intravenous (IV) infusion was an independent predictor of symptomatic intracranial hemorrhage (OR = 13.9, 95% CI: 5.1-84.5, p < 0.001). The mortality rate was 9.4% in-hospital and 12.2% at 90 days. Ninety-day mRS0-2 was 74.3%, mRS3-5 13.5%; stent patency was 93.2%. Heparin-limited-to-flush predicted patency loss on univariate (OR = 14.3, 95% CI: 1.5-53.1, p < 0.007) but not on multivariate analysis. Small-diameter balloon/absent post-dilatation was an independent predictor of stent patency loss (OR = 15.2, 95% CI: 5.7-73.2, p < 0.001). Conclusions: This largest to-date study of the MicroNET-covered stent in consecutive CRS patients demonstrated a high acute angiographic success rate, high 90-day patency and favorable clinical outcomes despite variability in procedural strategies and pharmacotherapy (SAFEGUARD-STROKE NCT05195658). [ABSTRACT FROM AUTHOR]

Abstract Objectives It is uncertain, if omitting post-dilatation and stent oversizing (stent optimization) is safe and may decrease the risk for distal thrombus embolization (DTE) in STEMI patients with large thrombus burden (LTB). Background In patients with ST-segment elevation myocardial infarction (STEMI) undergoing primary percutaneous coronary intervention (pPCI) with stenting, (DTE) and flow deterioration are common and increase infarct size leading to worse outcomes. Methods From a prospective registry, 74 consecutive STEMI patients with LTB undergoing pPCI with stenting and intentionally deferred stent optimization were analyzed. Imaging data and outcomes up to 2 years follow-up were analyzed. Results Overall, 74 patients (18% females) underwent deferred stent optimization. Direct stenting was performed in 13 (18%) patients. No major complications occurred during pPCI. Staged stent optimization was performed after a median of 4 (interquartile range (IQR) 3; 7) days. On optical coherence tomography, under-expansion and residual thrombus were present in 59 (80%) and 27 (36%) cases, respectively. During deferred stent optimization, we encountered no case of flow deterioration (slow or no-reflow) or side branch occlusion. Minimal lumen area (mm2) and stent expansion (%) were corrected from 4.87±1.86mm to 6.82±2.36mm (p

Objectives: It is uncertain, if omitting post-dilatation and stent oversizing (stent optimization) is safe and may decrease the risk for distal thrombus embolization (DTE) in STEMI patients with large thrombus burden (LTB). Background: In patients with ST-segment elevation myocardial infarction (STEMI) undergoing primary percutaneous coronary intervention (pPCI) with stenting, (DTE) and flow deterioration are common and increase infarct size leading to worse outcomes. Methods: From a prospective registry, 74 consecutive STEMI patients with LTB undergoing pPCI with stenting and intentionally deferred stent optimization were analyzed. Imaging data and outcomes up to 2 years follow-up were analyzed. Results: Overall, 74 patients (18% females) underwent deferred stent optimization. Direct stenting was performed in 13 (18%) patients. No major complications occurred during pPCI. Staged stent optimization was performed after a median of 4 (interquartile range (IQR) 3; 7) days. On optical coherence tomography, under-expansion and residual thrombus were present in 59 (80%) and 27 (36%) cases, respectively. During deferred stent optimization, we encountered no case of flow deterioration (slow or no-reflow) or side branch occlusion. Minimal lumen area (mm2) and stent expansion (%) were corrected from 4.87±1.86mm to 6.82±2.36mm (p<0.05) and from 69±18% to 91±12% (p<0.001), respectively. During follow-up, 1 patient (1.4%) required target lesion revascularization and 1 (1.4%) patient succumbed from cardiovascular death. Conclusions: Among STEMI patients with LTB, deferring stent optimization in the setting of pPCI appears safe and potentially mitigates the risk of DTE. The impact of this approach on infarct size and clinical outcomes warrants further investigation in a dedicated trial. [ABSTRACT FROM AUTHOR]

Chronic total occlusions (CTOs) represent the most complex subset of coronary artery disease and therefore careful planning of CTO percutaneous coronary recanalization (PCI) strategy is of paramount importance aiming to achieve procedural success, and improve patient's safety and post CTO PCI outcomes. Intravascular imaging has an essential role in facilitating CTO PCΙ. First, intravascular ultrasound (IVUS), due to its higher penetration depth compared to optical coherence tomography (OCT), and the additional capacity of real-time imaging without need for contrast injection is considered the preferred imaging modality for CTO PCI. Secondly, IVUS can be used to resolve proximal cap ambiguity, facilitate wire re-entry when dissection and re-entry strategies are applied and most importantly to guide stent deployment and optimization post implantation. The role of OCT during CTO PCI is currently limited to stent sizing and optimization, however, due to its high spatial resolution, OCT is ideal for detecting stent edge dissections and strut malapposition. In this review, we describe the use of intravascular imaging for lesion crossing, plaque characterization and wire tracking, extra- or intra-plaque, and stent sizing and optimization during CTO PCI and summarize the findings of the major studies in this field.

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Implantation of cardiovascular stents is an important therapeutic method to treat coronary artery diseases. Bare-metal and drug-eluting stents show promising clinical outcomes, however, their permanent presence may create complications. In recent years, numerous preclinical and clinical trials have evaluated the properties of bioresorbable stents, including polymer and magnesium-based stents. Three-dimensional (3D) printed-shape-memory polymeric materials enable the self-deployment of stents and provide a novel approach for individualized treatment. Novel bioresorbable metallic stents such as iron- and zinc-based stents have also been investigated and refined. However, the development of novel bioresorbable stents accompanied by clinical translation remains time-consuming and challenging. This review comprehensively summarizes the development of bioresorbable stents based on their preclinical/clinical trials and highlights translational research as well as novel technologies for stents (e.g., bioresorbable electronic stents integrated with biosensors). These findings are expected to inspire the design of novel stents and optimization approaches to improve the efficacy of treatments for cardiovascular diseases.

AimThe aim of this study was to explore the potential intraprocedural benefits of the Proximal Side Optimization (PSO) technique by Optical Coherence Tomography (OCT).MethodsA case series of 10 consecutive true bifurcation lesions, with severe long pathology of long side branch (SB), were randomly assigned to be treated by standard DK Crush procedure (non-PSO group) as compared to DK Crush in PSO modification (PSO group). The data from OCT investigation before crushing of the SB Drug-Eluting Stent (DES), after crushing, after first kissing balloon inflation (KBI), and after final angiography were compared between the two groups (Public trials registry ISRCTN23355755).ResultsAll 10 cases were successfully treated by the assigned technique. The two groups were similar in terms of indications for the procedure, bifurcation angle, and stent dimensions. As compared to the non-PSO, the PSO group showed larger proximal SB stent areas (5.8 ± 1.8 vs. 4.5 ± 0.5 mm2; p = 0.02), the larger delta between distal and proximal stent areas before crush (1.5 ± 0.7 vs. 0.6 ± 0.5 mm2; p = 0.004), and the larger Space of Optimal Wiring (SOW) after Crush (5.3 ± 1.8 vs. 2.5 ± 1.1 mm2; p = 0.02). The gaps in scaffolding within the ostial segment of the Side Branch DES were found in two patients from the non-PSO group.ConclusionThe DK Crush in PSO modification results in larger SB DES and SOW areas with better apposition to the vessel wall. As result, the SB DES acquires a funnel shape, which reduces the risk of passage outside the SB stent struts during re-wiring, thus, allowing predictable and secure results.

The healing process of acute incomplete stent apposition (ISA) in the early phase after stent implantation has not been well understood. We evaluated the temporal changes of ISA during the early phase after everolimus-eluting stent (EES) implantation using serial optical coherence tomography (OCT) analyses. Serial OCT examinations were performed immediately post-stenting and 2-week and 4-month after EES implantation for patients with ST-segment elevation myocardial infarction. At the most proximal cross-section of the implanted stent, the prevalence of ISA and maximum ISA distance were serially evaluated. In 45 patients with ST-segment elevation myocardial infarction, serial OCT analyses at 2-week and 4-month were performed. The prevalence of ISA gradually decreased over time, being 53.3% at baseline, 37.8% at 2-week follow-up, and 11.1% at 4-month follow-up (P < 0.001). The maximum ISA distance also decreased over time (P < 0.001). A receiver-operating curve analysis found that the optimal cut-off values of the baseline ISA distance for predicting persistent ISA at 2-week follow-up and 4-month follow-up were > 140 µm and > 215 µm, respectively. The baseline ISA distance was closely associated with the healing of ISA in the early phase after EES implantation. Maintaining the minimum ISA distance at post-stenting facilitates early phase healing of acute ISA. [ABSTRACT FROM AUTHOR]

Coronary angiography is routinely used to assess the extent and severity of coronary artery disease and for decision-making during percutaneous coronary interventions (PCI). However, it is sometimes inadequate for deciding a strategy and defining optimal stenting outcomes. In this review, we present a comprehensive and practical approach to PCI using intravascular ultrasound or optical coherence tomography to optimize stent deployment and assess procedural complications after stent implantation. [ABSTRACT FROM AUTHOR]

Current evidence and guidelines support the use of the single-stent technique as the default treatment strategy for the treatment of coronary bifurcations. For the single-stent technique, routine final kissing balloon inflation is not recommended, unless side branch ostial stenosis is assumed to be functionally significant. The double-stent technique is still a viable option for bifurcations with large and severely diseased side branches. Due to the unique features of bifurcation anatomy and bifurcation stenting techniques, all deployed stents should be optimized by postdilation, kissing balloon inflation and/or the proximal optimization technique, regardless of the stenting technique used. Intravascular ultrasound can guide preimplantation decision-making and postimplantation optimization by providing information on reference diameter, plaque burden and distribution, and stent underexpansion and malapposition. [ABSTRACT FROM AUTHOR]

Abstract: Objective: To evaluate the role of Frequency domain optical coherence tomography (FD-OCT) in guiding stent implantation procedures. Methods: Dragonfly™-imaging catheter was used pre-intervention, after pre-dilatation or at various stages of stent deployment/post-dilatation to assess lesion severity, characteristics and guide stent expansion/apposition. Results: We performed 398 OCT pull-backs in 108 consecutive patients. The 371 pull-backs analysable, had an average length of 35mm and encompassed 193 lesions (1.8 lesions per patient). Seventy-six percent of patient had AHA-ACC-class B–C lesions. In the pre-intervention group deferral of treatment was decided for 13/68 pullbacks (19.1%), whereas strategies different from conventional predilatation (e.g. thrombectomy, rotablator, cutting-balloon) were decided in 23 cases (33.8%). After full lesion dilatation 96 pullbacks (25.9%, pre-stenting group) were performed, 46 (47.9%) of which suggested proceeding directly with stenting while 50 (52.1%) suggesting further treatment. Out of the 207 pullbacks in post-stenting group, 29 (14%) suggested new stent implantation because of dissection or residual stenosis; 64 (30.9%) suggested further optimization with high pressure/larger-sized balloon. Average number of pull-backs per patient was 3.4 requiring 75.8±19.3ml of iopamidol. No major complications were observed. Five cases (4.6%) of contrast-induced nephropathy were reported. Conclusions: Repeated examinations with FD-OCT can be safely used to guide stent selection and improve stent expansion and apposition. [Copyright &y& Elsevier]

This study investigated the effect of fractional flow reserve (FFR) after stent implantation on clinical outcomes. Pressurewire measurements and follow-up data were obtained after stent implantation. Regarding the end point, target lesion revascularization (TLR) occurred in 11 patients (15.9 %). Patients with TLR had higher frequencies of multiple stenting (54.5 vs. 19.0 %, p = 0.01), lower post-interventional FFRs (0.84 vs. 0.88, p = 0.01), and longer stent lengths (42.20 vs. 27.69 mm, p = 0.01) than patients without TLR. The post-interventional FFR cutoff for TLR was 0.79, although this value had a weak discriminatory ability. However, multivariate analysis did not show any significant independent predictors of TLR (odds ratio 6.33; confidence interval 0.75-53.4, p = 0.09). Post-interventional FFR values were not significantly associated with TLR when a sub-analysis was performed in patients who underwent only drug-eluting stent (DES) implantation. It was difficult to achieve post-interventional FFRs of 0.9 or greater. DES implantation eliminated the effect of post-interventional FFR on TLR. Post-interventional FFR was not able to predict TLR in the present study. [ABSTRACT FROM AUTHOR]

From the bare metal stent era, studies have demonstrated improved procedural results and fewer complications when using intravascular ultrasound (IVUS) guidance, compared with angiography alone. In the drug-eluting stent (DES) era, predictors of DES restenosis and thrombosis such as under-expansion, incomplete stent apposition, and edge-related problems are readily detectable by IVUS. Pre-intervention and post-intervention IVUS measurements can help to achieve more adequate lesion coverage and the best possible stent expansion in order to eliminate the common predictors of DES failures and, perhaps, also result in reduced adverse clinical outcomes. [ABSTRACT FROM AUTHOR]

One of the leading causes of morbidity and mortality worldwide is coronary artery disease, a condition characterized by the narrowing of the artery due to plaque deposits. The standard of care for treating this disease is the introduction of a stent at the lesion site. This life-saving tubular device ensures vessel support, keeping the blood-flow path open so that the cardiac muscle receives its vital nutrients and oxygen supply. Several generations of stents have been iteratively developed towards improving patient outcomes and diminishing adverse side effects following the implanting procedure. Moving from bare-metal stents to drug-eluting stents, and recently reaching bioresorbable stents, this research field is under continuous development. To keep up with how stent technology has advanced in the past few decades, this paper reviews the evolution of these devices, focusing on how they can be further optimized towards creating an ideal vascular scaffold. [ABSTRACT FROM AUTHOR]

Purpose of Review: Intravascular imaging provides improved diagnostic accuracy and optimization of percutaneous coronary interventions (PCI) compared with angiography alone. We review the latest literature on the predominant intravascular imaging modalities, intravascular ultrasound (IVUS), and optical coherence tomography (OCT).Recent Findings: A number of recently published clinical studies evaluating OCT and IVUS use have demonstrated improved procedural and clinical outcomes over angiography. Recent literature also reports on novel potential applications of these technologies.Summary: Intravascular imaging is an important diagnostic tool that augments angiography. IVUS has been the primary adjunctive intravascular imaging modality in interventional cardiology over the past three decades, while OCT is a newer modality of growing clinical importance. Both modalities augment angiography alone while having their own specific advantages and disadvantages. [ABSTRACT FROM AUTHOR]