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Peter Mortier

Peter Mortier. Stent cell sizes: Important data for bifurcation stent selection (EuroIntervention, Accepted for publication). How do we define a stent cell?. During provisional stenting, these cells are often enlarged by balloon dilatation. Courtesy El-Jack et al.

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Peter Mortier

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  1. Peter Mortier Stent cell sizes: Important data for bifurcation stent selection (EuroIntervention, Accepted for publication)

  2. How do we define a stent cell?

  3. During provisional stenting, these cells are often enlarged by balloon dilatation Courtesy El-Jack et al

  4. In a perfect world, all stent struts should be in contact with the arterial tissue • Why? • To reduce the risk of stent thrombosis • To facilitate subsequent stent insertion in the side branch • To reduce the disturbance of the blood flow • To optimize drug delivery • If the stent cells are too small, this is not possible!

  5. New method to determine cell size based on in-house developed micro-CT imaging facilities Cypher stent (Cordis, J&J) Equivalent diameter

  6. Overview of investigated stents Endeavor (Medtronic) PRO-Kinetic (Biotronik) Promus (Boston Scientific) Taxus Liberté (Boston Scientific)

  7. Cell sizes differ considerably All stents have a nominal diameter of 3 mm * The platform of the Promus DES is identical to the platform of the Xience V (Abbott Vascular) DES

  8. Size of the ostium 90° 45°

  9. Ostium circumference calculation • The circumference of the ostium (red line) can be calculated in the idealized case of two intersection cylindrical tubes • The ostium circumference depends on three parameters: • Main branch diameter • Side branch diameter • Angle of intersection

  10. The ostium circumference increases rapidly for smaller bifurcation angles • For a 3 mm main branch 3 different side branch diameters

  11. Combining information of the ostium and stent cell size • Stent cell circumference should preferably be as large as the ostium circumference • Applying this criterion does not guarantee that all struts will be in contact with the tissue! • But, it helps to select stents which have at least the potential to be sufficiently enlarged

  12. Cypher stent • For a 3 mm main branch

  13. Promus/Taxus Liberté • For a 3 mm main branch

  14. Limitations • Real-life bifurcations have a much more complex geometry • The criterion is too strict in case of stents partially deploying within the side branch • Stent selection depends on a large number of aspects and cell size is just one of them (e.g. closed cell design may provide better scaffolding)

  15. New stent research tools

  16. Virtual expansion of the Cypher stent

  17. Model results correspond well with data provided by the manufacturer Data manufacturer Simulation results

  18. Simulated stent shape corresponds with experimentally observed shape

  19. These computer models can also be used to study bifurcation stenting Mortier et al, Medical Engineering and Physics, accepted for publication

  20. These models can accurately predict stent distortion Multi-Link VisionTM stent 2.5 mm balloon MultiLinkTM stent 3.0 mm balloon Ormiston et al., 1999

  21. Conclusions • Cell sizes • Stent cell sizes differ considerably • The proposed criterion helps to select stents which have cells that can be sufficiently enlarged • However, this does not guarantee optimal strut positioning • Virtual tools • Computer models can accurately predict stent deployment/distortion • These models may help to investigate different bifurcation stenting techniques • Such models provide a platform to design and to optimize dedicated bifurcation stents

  22. Thank you! • Acknowledgements • Matthieu De Beule • Denis Van Loo • Benedict Verhegghe • Yves Taeymans • Patrick Segers • Pascal Verdonck • More information • http://www.stent-ibitech.ugent.be

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