CASE: Stentys Xposition S

Dr Weilenmann, St Gallen, Switzerland, shares a case that demonstrates the need to have a  Self-Apposing stent on the shelf. In this case, a straight forward revascularisation of a CTO revealed a severely tapered LAD with a large mismatch in calibre between the distal and proximal vessels.

A large discrepancy between the proximal and distal vessel diameter creates a challenge for conventional drug eluting stents. There is a risk of oversizing the stent in the distal vessel, which may lead to an over dilation of the artery and subsequent dissection and excessive barotrauma. An undersized stent in the proximal segment may lead to malapposed stent struts and uncovered stent struts, which have been linked to higher rates of stent thrombosis, restenosis and acute MI.

Using a Self-Apposing stents in these vessels avoids the dilemma of stent sizing, and minimises the need for additional stent optimisation to gain complete apposition.

 

Key Learning Points

+ Vessels with discrepancies in vessel diameter are not uncommon and are not always expected.
+ Managing cases with balloon expandable DES may be challenging in terms of stent sizing and stent optimisation.
+ Self-Apposing stents achieve complete stent apposition along the length of a tapered lesion, without the need for additional stent optimisation.