Stents auto-expansíveis versus balão-expansíveis para tratamento de lesões em vasos de fino calibre: Estudo com ultra-som intracoronário tridimensional

Abstract

Background: Percutaneous coronary intervention in small vessels (SV) is associated with poor short- and long-term outcomes, with high rates of restenosis. Previous studies have suggested that self-expanding stents can cause less vessel injury at implantation, expanding their volumes over time, and leading to larger luminal areas than those of balloon-expandable stents. The influence of these phenomena on SV remains unknown. Objectives: To assess the mechanical properties and efficacy of the novel CardioMind™ stent in comparison with the balloon-expandable Multi-Link Pixel™ (Pixel) stent in the treatment of SV. Methods: Thirteen patients with single, de novo, < 14 mm length lesions in native coronary arteries < 2.5 mm in diameter were treated with the CardioMind™ stent and compared with a historical cohort of 25 patients, with the same inclusion criteria, treated with the Pixel™ stent. Intravascular ultrasound (IVUS) was performed serially after the procedure and at 7.3 ± 1.0 months of follow-up. Results: Mean age was 58.1 ± 9.9 years; 60.5% were male and 39.4% were diabetic. Both stents produced similar neointimal hyperplasia (NIH) volumes (indexed NIH volume: 1.45 ± 0.46 mm3/mm for CardioMind™ versus 1.66 ± 1.02 mm 3/mm for Pixel™; p = 0.48). However, the CardioMind™ stent presented a 12% expansion of its volume, leading to a lesser in-stent volumetric obstruction (31.94 ± 8.19% versus 39.90 ± 4.72%; p = 0.0005). Injury at the edges of the CardioMind™ and Multi-Link Pixel™ stents were not detected. Conclusions: Serial volumetric IVUS showed that CardioMind™ and Pixel™ stents produced similar volumes of neointimal tissue. However, continued expansion of CardioMind™ stent generated larger luminal volumes and lower percent in-stent volumetric obstruction. The two stents were harmless to the edge segments.