Effects of stent post-dilatation during primary percutaneous coronary intervention for ST-segment elevation myocardial infarction

Karamasis, Grigoris V. (2019) Effects of stent post-dilatation during primary percutaneous coronary intervention for ST-segment elevation myocardial infarction. Doctoral thesis, Anglia Ruskin University.

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Abstract

In patients presenting with ST-elevation myocardial infarction (STEMI), optimal stent deployment is challenging due to factors like thrombus formation and vasoconstriction. Post-dilatation (PD) with non-compliant (NC) balloons could optimise acute procedural results, but in the context of STEMI it has been associated with the no-reflow phenomenon and microvascular injury. This thesis aimed to investigate the impact of PD on coronary microcirculation in STEMI patients. Furthermore, it meant to explore the effect of PD on features of stent deployment and any potential relationship between post-stenting residual in-stent athero-thrombotic prolapse (ATP) and changes in microvascular function. Consecutive STEMI patients undergoing primary PCI were recruited in the context of a prospective observational study (POSTDIL-STEMI, NCT02788396). Advanced physiological measurements and intracoronary imaging with optical coherence tomography (OCT) were performed immediately before and after PD. The index of microcirculatory resistance (IMR), coronary flow reserve (CFR) and fractional flow reserve (FFR) were measured. IMR was used as a marker of microvascular function before and after post-dilatation. OCT was used to assess stent expansion, malapposition, residual in-stent ATP and stent edge dissections. The potential correlation of residual ATP with changes in IMR (dIMR) was assessed. Overall IMR and CFR did not change significantly after PD, while FFR showed an increase. At individual patient level, microvascular function improved in half of the patients and deteriorated in the other half. Correlation analysis did not show any relation between different measures of ATP and dIMR. PD improved stent expansion, reduced malapposition, had a mixed effect on residual ATP and non-significant effect on stent edge dissections. POSTDIL-STEMI study showed that PD in the context of STEMI did not result in consistent and predictable microvascular injury. There was no correlation found between the residual in-stent ATP and changes in microvascular function. Finally, PD significantly improved most of the features of stent expansion.

Item Type: Thesis (Doctoral)
Keywords: STEMI, primary PCI, post-dilatation, NC balloons, coronary microcirculation, IMR, OCT
Faculty: Theses from Anglia Ruskin University
Depositing User: Lisa Blanshard
Date Deposited: 21 May 2020 10:53
Last Modified: 09 Sep 2021 18:54
URI: https://arro.anglia.ac.uk/id/eprint/705557

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