Novel Insight into the "Geographical Miss Phenomenon": Device Motion Indicator, a New Feature to Evaluate Relative Axial Stent Movement inside Coronary Artery and to Facilitate its Precise Deployment Site

Background: Geographical miss describes the phenomenon of suboptimally deployed coronary stent, known to occur frequently and accused in higher restenosis, TLR, MI, and stent thrombosis. Yet, the exact nature and extent of GM is not known.

Methods The Sync-Rx System (system) is an add-on image processing system with unique enhancement and stabilization capabilities. A new feature of it, the device motion indicator (DMI), can detect and measure its relative balloon`s axial movements. Using the DMI, we measured the pre-deployment, relative balloon movement in the coronaries and their sub-segments in patients undergoing PCI. The simultaneously calculated DMI values were translated to extra stent length aiming to avoid/neutralize geographical miss.

Results: 197 patients underwent PCI, mostly for ACS (87%), with the system support. 225 branch point sites (1.15 ± 0.4 per patient) were identified. Median longitudinal DMI was 2.976 mm ± 0.45 in the RCA segments, 1.846 mm ± 0.23 in the LAD segments and 2.22 mm ± 0.4 at the LCX segments. The most movable segment was the distal RCA (P

Conclusions: The newly described DMI is a fundamental contributor for GM. At stent deployment the interventionist postulate that he gets just what he meant. However, two major parameters jeopardize this wishful thinking; the determination of lesion`s dimensions is mostly subjective&inaccurate, and the working platform is a dynamic rather than static; these parameters are adequately addressed by the System.

With the system we can translate the DMI to extra stent length to better cover the presumably diseased segment and avoid GM with its hazardous consequences.