Predictors and Long-Term Clinical Outcome of Longitudinal Stent Deformation

Aims: There are limited data on the frequency of and factors associated with quantitative coronary angiography (QCA)-defined longitudinal stent deformation (LSD). We sought to evaluate the predictors of LSD and its long-term clinical implication.
Methods and results: A patient-level pooled analysis was performed with 7,350 lesions in 5,871 patients treated with PtCr-EES (Promus Element), CoCr-EES (Promus/Xience V), or CoCr-ZES (Endeavor Resolute). QCA was performed to analyse the difference of stent length between immediate post-deployment and final post-procedure. Independent factors associated with LSD were identified. Clinical outcomes at 3-year were compared between those with and without QCA-based LSD.
The frequency of QCA-based LSD was 1.12% (82 cases). Nine of these cases were angiographically overt. Left main or ostial lesion, bifurcation treatment with provisional side branch stenting or ballooning, additional downstream intervention of a distal lesion, intravascular ultrasound use, and adjunctive post-dilatation were independently associated with QCA-based LSD. The type of stent was not associated with QCA-based LSD. Rates of target lesion failure were not significantly different between groups with or without QCA-based LSD (8.97% vs. 5.88%, HR 1.415, 95% CI 0.631-3.175, p=0.399).
Conclusions: LSD is uncommon with contemporary DES, regardless of the type of stent platform. LSD is mainly associated with procedural factors, especially with additional downstream procedures which require the passage of devices through the stent. Careful manipulation of post-stent imaging or procedural devices is required to prevent LSD. More data are needed to clarify the impact of LSD on clinical events.