Longitudinal Stent Deformation: Precise Diagnosis With Optical Coherence Tomography

J INVASIVE CARDIOL 2019;31(12):E395.

Key words: angioplasty, complications, longitudinal stent deformation

Longitudinal stent deformation (LSD), defined as the distortion or shortening of a stent in the longitudinal axis following successful stent deployment, has been recognized as an important complication of coronary angioplasty. It is caused by impact on a deployed stent by a device (such as a guide catheter or guide-catheter extension) or secondary devices (such as postdilation balloons) as a result of guidewire bias as well as the inherent mechanical properties of the stent itself. This complication may be difficult to detect angiographically,  and the use of intravascular ultrasound or optical coherence tomography (OCT) can help confirm the diagnosis and guide treatment decisions, as well as avoid complications like stent thrombosis. Angiographically, LSD should be suspected with the appearance of new-onset stenosis or with an increased radiopacity in the proximal segment after stent deployment.

We present the case of a 76-year-old patient with a history of multivesssel disease and previous stents who was admitted for a new episode of angina. Right coronary artery (RCA) angiography showed a severe stenosis at the proximal segment, and a significant in-stent restenosis at the mid segment. A 3.0 x 12 mm Resolute Onyx stent (Medtronic) was implanted in the proximal RCA with excellent angiographic result. Then, a 2.75 x 26 mm Orsiro stent (Biotronik) was implanted at the mid segment of the RCA (Figures 1A and 1B). After removing the balloon from the second stent, in a new angiographic view, an increased radiopacity of the proximal edge of the ostial stent was seen, so LSD was suspected (Figure 1C). OCT showed longitudinal deformation/compression of the ostial RCA stent. Some of the proximal stent struts were visualized alongside distorted and crumpled malapposed stent struts before the guide catheter  in the proximal segment on 3-dimensional rendering (Figures 1D-1F). The deformed portion of the ostial RCA was successfully stented further with a 3.0 x 9 mm Orsiro drug-eluting stent.  

This case illustrates the value of OCT to identify and correctly diagnose longitudinal stent deformation.

From the Hospital Universitario La Paz, Madrid, Spain.

Disclosure: The authors have completed and returned the ICMJE Form for Disclosure of Potential Conflicts of Interest. The authors report no conflicts of interest regarding the content herein. 

The authors report that patient consent was provided for publication of the images used herein.

Manuscript accepted March 5, 2019.

Address for correspondence: Harold Hernández-Matamoros, MD, Hospital Universitario La Paz, Paseo de la Castellana, 261, 28046 Madrid, Spain. Email: dr.hernandezh@gmail.com