Stent deployment in calcified lesions: Can we overcome calcific restraint with high-pressure balloon inflations?

Although significant coronary artery (CA) calcification is believed to affe ct stent deployment, the exact impact on stent deployment after high-pressu re balloon inflations is unknown. Intracoronary intravascular examination ( ICUS) was performed in 27 moderate-severe calcified CA lesions before and a fter stent implantation. In case of unsatisfactory results (in-stent area < 90%, minimal in-stent diameter/maximal in-stent diameter < 0.8), further i nflations up to 20 atm guided by ICUS were applied. Initially, stent expans ion was adequate in 10 stents (37%) and symmetric in 19 (70%). After inflat ion at 20 atm, stents with adequate expansion increased to 16 (59%, P = 0.0 036), but stents with symmetry decreased to 13 (48%, P = 0.0045). Stent exp ansion was inversely correlated to the are of calcium (r = -0.8, P < 0.0001 ). There were five patients with clinical restenosis at 6 months (18%). Inc reases in stent lumen area with high-pressure balloon inflations in moderat e-severe calcified CA lesions are at the expense of symmetry. This may affe ct clinical restenosis. Cathet Cardiovasc Intervent 2001;52:164-172. (C) 20 01 Wiley-Liss, Inc.