Optimization of stent implantation using a high pressure inflation protocol

Srikanth Vallurupalli, Amit Bahia, Ernesto Ruiz-Rodriguez, Zubair Ahmed, Abdul Hakeem, Barry F. Uretsky

Research output: Contribution to journalArticlepeer-review

9 Scopus citations

Abstract

Background High-pressure inflation is the universal standard for stent deployment but a specific protocol for its use is lacking. We developed a standardized "pressure optimization protocol" (POP) using time to inflation pressure stability as an endpoint for determining the required duration of stent inflation. Objectives: The primary study purpose was to determine the stent inflation time (IT) in a large patient cohort using the standardized inflation protocol, to correlate various patient and lesion characteristics with IT, and ascertain in an in vitro study the time for pressure accommodation within an inflation system. Methods Six hundred fifteen stent implants in 435 patients were studied. Multivariate analysis was performed to determine predictors of longer ITs. In an in vitro study, various stents and balloons were inflated in air to determine the pressure accommodation time of the inflation system. Results The mean stent IT was 104 ± 41 sec (range 30-380 sec). Stent length was the only predictor of prolonged stent inflation. The "accommodation time" in vitro of the stent inflation system itself was 33 ± 24 sec. The protocol was safe requiring premature inflation termination in <3% of stent implants. No serious adverse events occurred. Conclusions Achieving stable inflation pressure requires on average over 100 sec and may require several minutes in individual cases. Stent length increases IT. These results suggest that the widespread practice of rapid inflation/deflation may not be sufficient to fully expand the stent and that the use of a pressure stability protocol will allow for safe, predictable, and more complete stent deployment.

Original languageEnglish (US)
Pages (from-to)65-72
Number of pages8
JournalCatheterization and Cardiovascular Interventions
Volume87
Issue number1
DOIs
StatePublished - Jan 1 2016

Keywords

  • angioplasty
  • coronary stenting
  • percutaneous coronary intervention
  • stenting technique

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