Proximal Anchoring Technique: A Novel Technique to Prevent Coronary Stent Longitudinal Deformation

Background: Precise coronary stent implantation is crucial for ostial and partial bifurcation lesions during percutaneous coronary intervention (PCI). Conventional post-dilation coronary stent implantation often causes longitudinal stent deformation (LSD); meanwhile, even a small area of protrusion into the proximal main branch (MB) can lead to severe problems. This study aimed to introduce a novel post-dilation technique, the proximal anchoring technique (PAT), and evaluate the associated feasibility and efficacy in achieving precise stent implantation and preventing LSD. Methods: This bench study was performed in a tapered silicon vessel model, in which 3.5 × 28 mm-sized everolimus-eluting stents (Xience Xpedition™; Abbot, USA) were deployed at a nominal pressure. Post-dilation was conducted using two different strategies: the proximal anchor followed by distal post-dilation group (PAT group) and the conventional post-dilation group (dilation from distal to proximal) (D-P group). After each step, the subsequent changes in stent length were measured by optical coherence tomography (OCT). Additionally, three clinical PCI cases in which PAT and conventional post-dilation were employed are presented. Results: The longitudinal elongation of stents was significantly increased in the D-P group compared with the PAT group (p < 0.001). The OCT measurements showed that the stents were elongated during every step of the procedure in the D-P group (29.35 ± 0.10 mm vs. 29.65 ± 0.10 mm; p = 0.0054), but only slightly elongated in the first step of the post-dilation in the PAT group (28.73 ± 0.12 mm vs. 28.87 ± 0.12 mm; p = 0.2262). Conclusions: We present a novel technique, PAT, to assist in more precise coronary stent implantation by preventing LSD for partial ostial and bifurcation lesions during PCI.