Mudit Gupta, Ella B. Leeth, Yuval Barak-Corren, Ari J. Gartenberg, Elizabeth Silvestro, Michael L. O’Byrne, Ryan Callahan
Children’s Hospital of Philadelphia and University of Pennsylvania Perelman School of Medicine. Akron Children’s Hospital and Northeast Ohio Medical University.
United States
Catheterization and Cardiovascular Interventions
Catheter Cardiovasc Interv 2025;
DOI: 10.1002/ccd.31428
Abstract
Background and aims: Drug-eluting stents (DES) are not designed for overexpansion to supra-nominal diameters or intentional stent fracture (ISF). The optimal dilation technique to minimize stent shortening (SS) and achieve ISF to accommodate pediatric somatic growth has not been described.
Methods: Three sizes of two commonly used DES were implanted within a silicone model to simulate blood vessels. Each stent was serially dilated in 1 mm increments under fluoroscopy using three techniques: 2 cm length, semi-compliant balloons (Technique 1), 2 cm, noncompliant balloons straddling the entire stent (Technique 2), or noncompliant balloons in an “inside-out” manner (balloon shorter than stent or 2 cm balloon aligned with distal end of stent (no straddle); (Technique 3). Technique 1 crossed over to noncompliant balloons once stent “napkin-ringed” (NR). Percent SS = (Lnominal – Lfinal)/Lnominal * 100.
Results: Technique 1 resulted in the greatest SS (median 85%, IQR 82, 87) and universal napkin ringing. Technique 2 caused less SS (median 14%, IQR 7, 15), and Technique 3 caused the least SS (median 7%, IQR 3, 11). ISF was achieved in all, however, the inside-out technique caused ISF at smaller stent diameters (median 114% recommended postdilation limit vs. 122%-131%) and lower inflation pressures (median 15 vs. 28-29 ATM). ISF was achieved in Technique 1 after napkin ringing but required larger noncompliant balloons than other techniques (median 8.5 vs. 7 mm).
Conclusion: Inside-out dilation resulted in less SS and fracture at smaller diameters with lower inflation pressures. This technique may improve the ISF success rate of DES in pediatric patients.
Category
Surgical and Catheter-mediated Interventions for Pulmonary Vascular Disease
Mechanical and Computer Models of Pulmonary Vascular Disease and Therapy
Age Focus: Pediatric Pulmonary Vascular Disease
Fresh or Filed Publication: Fresh (PHresh). Less than 1-2 years since publication
Article Access
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