VESSEL TEARING AT THE EDGE OF INTRACORONARY STENTS DETECTED WITH INTRAVASCULAR ULTRASOUND IMAGING

Stent deployment strategies have changed significantly in the past 2 y r, with ''high-pressure'' balloon inflations postdilatation being perf ormed in the large majority of cases, There is currently little inform ation about the effects of high pressure on the geometry of stent expa nsion and on the adjacent areas of the vessel wall, Intravascular ultr asound (IVUS) imaging is well-suited to investigate these issues, sinc e it provides information not only about stent expansion and appositio n but also about adjacent vessel-wall morphology at transition points such as the articulation site of the stent and the stent borders. We r eport on the results of a cohort of 30 consecutive stent cases which w ere systematically examined by IVUS following high-pressure inflation. All deployments were deemed successful by angiographic inspection. Ho wever, in 6 cases, intimal disruptions or ''edge tears'' were noted at the stent borders by IVUS, In 5 cases, edge tears were seen to occur at the distal border, whereas in one case edge tears were seen at both the proximal and distal edges of the stent. No angiographic and sonog raphic parameters were different except percent plaque area at the ste nt margins, which was significantly higher(53 +/- 11%) in the lesions with edge tears, compared to 40 +/- 10% plaque area in the group witho ut evidence of pocket flaps (P = 0.007). This experience suggests that intimal disruptions or ''edge tears'' are a relatively common occurre nce following high-pressure stent deployment, and may be related to th e extent of marginal dissections. (C) 1997 Wiley-Liss, Inc.