Alejandro González Veliz: Understanding and Managing Stent Underexpansion
Alejandro González Veliz, Interventional Cardiologist at Institute of Cardiology and Cardiovascular Surgery, shared a post on LinkedIn:
“Stent underexpansion: the enemy we must recognize
Stent underexpansion is one of the most important mechanical mechanisms of PCI failure and a major contributor to in stent restenosis and stent thrombosis.
But why does it happen?
Severe coronary calcification, inadequate lesion preparation, inappropriate stent sizing and insufficient balloon expansion are among its main contributing factors.
What should we do to prevent it?
- Identify and assess coronary calcium before stent implantation.
- Perform adequate lesion preparation.
- Use IVUS or OCT to guide and optimize PCI.
- Evaluate the minimum stent area (MSA).
- Confirm optimal expansion before concluding the procedure.
Remember: angiography alone may provide false reassurance.
A stent can look satisfactory angiographically while remaining significantly underexpanded.
When underexpansion occurs, treatment should be guided by intravascular imaging and the underlying mechanism.
High pressure non compliant balloons are often the first approach, while selected resistant cases may require advanced techniques such as intravascular lithotripsy or excimer laser.
The goal is not simply to implant a stent. It is to achieve optimal expansion and a durable result.
Because in interventional cardiology, technical success goes beyond opening an artery.”
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