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Response of five types of contemporary drug-eluting stents to aggressive partial post-dilatation: a scanning electron microscopy study

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(1)Response of Five Types of Contemporary Drug‐Eluting Stents to  Aggressive Partial Postdilatation as Assessed by  Scanning Electron Microscopy Scanning Electron Microscopy M.W.Z. Basalus1, K. Tandjung1, A.A. van Apeldoorn2, M.J.K. Ankone2, P.K.N. van der Jagt2, G.J. Pelgrim2, C. von Birgelen1,2. Purpose. To assess the shape and incidence of coating irregularities on durable polymerpolymer-. Cypher Select. based drugdrug-eluting stents (DES) following extremely oversized aggressive partial postpostdilatation In clinical practice, dilatation. practice DES postpost-dilatation is often performed to avoid malapposition (e.g. in lesions with significant vessel tapering or rigid, calcified lesions). Sometimes even extremely oversized partial postpost-dilation of DES may be required, which exposes the stent to extreme forces. The influence of such maneuvers on DES coatings, however, is greatly unknown.. unknown. Methods Micro Methods.  Micro--computed tomographic data of our group recently demonstrated that oversized partial postpost-dilatation leads to a particularly high stent deformation between the nonnon-post post--dilated and postpostdilated stent regions. Accordingly, we performed such a maneuver in 15 DES (three 3.5mm3.5mm-samples of Cypher Select Plus, Taxus Liberté, Liberté, Endeavor Sprint, Endeavor Resolute, and Xience V) after deployment in water at 14 atm. All DES were e ep proximally o a y post post--d dilated ated with t a an oversized nonnon-compliant balloon (5.0mm at 18atm; see panel on right hand side) and examined with scanning electron microscopy.. microscopy. Results. Shape p and incidence of coating g irregularities in the postpost-dilated and transitional region of DES differed mildly from the nonnon-oversized stent region. In Taxus Liberté one additional irregularity (torn webbing) and more wrinkles were observed (p<0.05, (p<0 05 both) both), while in Endeavor Resolute more and larger cracks were observed (p<0.001).. Non-postdilated region. Transitional region. Postdilated region. Non-postdilated region. Transitional region. Postdilated region. Non-postdilated region. Transitional region. Postdilated region. Non-postdilated region. Transitional region. Postdilated region. Endeavor Sprint. 14 atm deployment. X ray X-ray. Endeavor Resolute. Postdilatation. X-ray. Xience V. Taxus Liberté Partially torn webbing. W bbi Webbing. Completely torn webbing. (1) Thoraxcentrum Twente, Department of Cardiology, Medisch Spectrum Twente, Enschede, NL  (2) University of Twente, MIRA – Institute for Biomedical Technology & Technical Medicine, Enschede, NL. Conclusions.  Only a single additional coating irregularity – torn webbing bbi – was observed b d iin one DES ttype following f ll i extremely t l oversized partial post post--dilatation. This bench side study in five types of durable polymerpolymer-based DES suggests that aggressive post post--dilatation generally shows only mild effects on (bio (bio--)durable polymer coatings..

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