Continued expansion of the nitinol self-expanding coronary stent: Angiographic analysis and 1-year clinical follow-up

• Published in: The American heart journal Vol. 138; no. 2; pp. 326 - 333
• Main Authors: Roguin, Ariel, Grenadier, Ehud, Linn, Shai, Markiewicz, Walter, Beyar, Rafael
• Format: Journal Article
• Language: English
• Published: New York, NY Mosby, Inc 01.08.1999; Elsevier
• Subjects: Alloys; Biological and medical sciences; Coronary Angiography; Coronary Disease - therapy; Diseases of the cardiovascular system; Female; Follow-Up Studies; Humans; Male; Medical sciences; Prosthesis Design; Radiotherapy. Instrumental treatment. Physiotherapy. Reeducation. Rehabilitation, orthophony, crenotherapy. Diet therapy and various other treatments (general aspects); Stents; Human; Prognosis; Radiodiagnosis; Follow up study; Coronary artery; Instrumentation therapy; Implantation; Instrumental dilatation; Coronary arteriography; Technique; Stent; Technical equipment
• ISSN: 0002-8703; 1097-6744
• DOI: 10.1016/S0002-8703(99)70120-1

Background This study sought to report the first-year clinical outcome with the nitinol self-expanding coil stent and to provide angiographic data on the effect of self-expansion during implantation and follow-up. Self-expanding stents do not reach their nominal diameter at implantation. The long-term effects may therefore depend, in part, on continued expansion after initial implantation. Methods Between January 1995 and January 1996, 86 stents were deployed in 64 patients for indication of suboptimal results. All patients were clinically followed up for 1 year, and 72% had follow-up angiography. Results The majority (55%) of the lesions were class B2 or C. Balloon angioplasty increased the minimal lumen diameter from 1.07 ± 0.73 mm to 2.24 ± 0.57 mm; stent deployment further increased the diameter to 2.63 ± 0.48 mm, and within-stent balloon dilatation to 2.96 ± 0.62 mm. Angiographic follow-up performed at 7.8 ± 1.1 months (range 7-9 months) showed that the minimal lumen diameter was 2.15 ± 0.80 mm (late lumen loss of 0.81 ± 0.69 mm), and the mean stent diameter expanded to 3.58 ± 0.48 mm (self-expanding late stent gain of 0.62 ± 0.55 mm). The extent of this expansion was inversely related to the late lumen loss ( r = 0.67, slope 0.81, P < .01). At 1 year 51 (80%) of 64 patients were event free; 3 had undergone coronary artery bypass grafting, 2 had had a myocardial infarction, and 9 had repeat angioplasty. In the subgroup of a simple lesion (<15 mm) covered by 1 stent, 18 (86%) of 21 patients were event free. Conclusions The self-expanding nitinol stent exerts its acute effect on minimal lumen diameter through its intrinsic radial force aided by balloon expansion. The stent continues to expand until it reaches its nominal diameter over the follow-up period. The extent of this expansion is inversely related to the late lumen loss, leading to an acceptable rate of long-term clinical events in this first cohort of patients with complex disease morphology. (Am Heart J 1999;138:326-33.)