The Sequence of Post‐Dilation Matters: Proximal Optimization Technique (POT) Reduces Longitudinal Stent Deformation Assessed by Intravascular Ultrasound

BACKGROUND: Longitudinal stent deformation (LSD) is a potentially serious complication of percutaneous coronary intervention (PCI). Although post-dilation is a known risk factor for LSD, the influence of procedural factors such as dilation sequence remains poorly understood. AIMS: This study aimed to identify procedural factors associated with LSD, with a focus on post-dilation technique. METHODS: In 529 patients (533 vessels) undergoing intravascular ultrasound (IVUS)-guided PCI, stent length was measured after post-dilation. Patients were categorized based on length change: elongation (> 2 mm or > 10% of nominal stent length; n = 71), unchanged (±2 mm or < 10% of nominal stent length; n = 457), and shortening (> 2 mm or > 10% of nominal stent length; n = 1, likely attributable to measurement error and not statistically significant). Procedural and lesion characteristics were analyzed. RESULTS: In univariate analysis, post-dilation sequence (p < 0.01) and balloon length (p < 0.05) differed between groups. In multivariate logistic regression, a distal-to-proximal dilation sequence (OR 3.13, 95% CI 1.2-10.81) and higher LVEF (OR 1.07, 95% CI 1.02-1.12) were independently associated with stent elongation. Stent placement at ostium was protective (OR 0.45, 95% CI 0.16-0.96). In the elongation group, positive correlations were observed between elongation magnitude and lesion length, stent length, and dilation sequence (all p < 0.05). CONCLUSION: The post-dilation sequence significantly influences LSD. Initiating dilation from the proximal stent segment-known as the proximal optimization technique (POT)-may reduce the risk of stent deformation.