Key result
BES with POT reduces trapped thrombus ~67% versus isolated BES in a bifurcation bench model.
Why the study?
Thrombus burden management during pPCI carries high risks of stent malapposition and thrombus embolization, especially when involving a coronary bifurcation.
Does the choice of stent strategy (BES, BES+POT, SAS) affect thrombus trapping, embolization, and stent apposition in a coronary bifurcation bench model?
Does the choice of stent strategy (BES, BES+POT, SAS) affect thrombus trapping, embolization, and stent apposition in a coronary bifurcation bench model?
In an experimental bifurcation bench model, balloon-expandable stents provided the best thrombus trapping, while self-apposing stents and BES with proximal optimization achieved better final stent apposition.
Answers are grounded in this paper and cite their sources.
Bench model suggests isolated BES may trap more thrombus; leaves open whether POT or self-apposing stents reduce embolization in vivo.
BACKGROUND: Management of thrombus burden during primary percutaneous coronary intervention (pPCI) is a key-point, given the high risk of stent malapposition and/or thrombus embolization. These issues are especially important if pPCI involves a coronary bifurcation. Herein, a new experimental bifurcation bench model to analyze thrombus burden behavior was developed. METHODS: On a fractal left main bifurcation bench model, we generated standardized thrombus with human blood and tissue factor. Three provisional pPCI strategies were compared (n = 10/group): 1) balloon-expandable stent (BES), 2) BES completed by proximal optimizing technique (POT), and 3) nitinol self-apposing stent (SAS). The embolized distal thrombus after stent implantation was weighed. Stent apposition and thrombus trapped by the stent were quantified on 2D-OCT. To analyze final stent apposition, a new OCT acquisition was performed after pharmacological thrombolysis. RESULTS: Trapped thrombus was significantly greater with isolated BES than SAS or BES+POT (18.8 ± 5.8% vs. 10.3 ± 3.3% and 6.2 ± 2.1%, respectively; p < 0.05), and greater with SAS than BES+POT (p < 0.05). Isolated BES and SAS tended show less embolized thrombus than BES+POT (5.93 ± 4.32 mg and 5.05 ± 4.56 mg vs. 7.01 ± 4.32 mg, respectively; p = NS). Conversely, SAS and BES+POT ensured perfect final global apposition (0.4 ± 0.6% and 1.3 ± 1.3%, respectively, p = NS) compared to isolated BES (74.0 ± 7.6%, p < 0.05). CONCLUSIONS: This first experimental bench model of pPCI in a bifurcation quantified thrombus trapping and embolization. BES provided the best thrombus trapping, while SAS and BES+POT achieved better final stent apposition. These factors should be taken into account in selecting revascularization strategy.
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Hayek et al. (2023) studied Thrombus burden during primary coronary bifurcation intervention (n=30). Balloon-expandable stent with proximal optimizing technique (BES+POT) or self-apposing stent (SAS) vs. Isolated balloon-expandable stent (BES) was evaluated on Trapped thrombus quantified on 2D-OCT (p=<0.05). In a bifurcation bench model, isolated balloon-expandable stents trapped significantly more thrombus (18.8%) than self-apposing stents (10.3%) or BES with proximal optimizing technique (6.2%).
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