CardioExchange Archive

CardioExchange, an NEJM practice community for medical professionals dedicated to improving cardiac patient care, was active from 2009 to 2015. CardioExchange fostered discussion between clinicians from across the globe.

January 6th, 2010

Stent Gap Rap

According to a recent study using computed tomographic angiography (CTA), the incidence of so-called stent gaps — due to stent strut fracture or failure to overlap stents — is 17%.  These stent gaps are associated with an increased incidence of in-stent restenosis. Interestingly, stent gaps were identified in only 1% of routine coronary angiography procedures.
 
Given these data, should we routinely be doing IVUS at the time of insertion of overlapping stents to verify that the stents do, in fact, overlap?

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2 Responses to “Stent Gap Rap”

  1. John K. Forrest, MD says:
    January 11, 2010 at 10:06 am

    Certainly IVUS can be useful in determining whether a stent is fully deployed and an argument could be made that it should be used after most stent placements.

    Per the article, ‘apparent causes of the gaps included stent fractures, failure to overlap stents, and crushed stents.’

    What I am not clear about is whether placement of another stent is indicated if you see a small gap between two stents or a stent fracture. I suspect such decisions are likely on a case basis. The suggestion of the article is that t if you have a small gap between two stents then a third stent should be placed to cover this gap.

  2. Richard A. Lange, MD, MBA says:
    January 11, 2010 at 2:41 pm

    Now what?

    I agree with you, John….the study implies that nonoverlapping stents should be “bridged” with another stent. Many interventionalists would not have difficulty with this approach. However, what to do with a stent fracture is more contentious, in my opinion. Is it better to place another stent — with its attendant potential complications — or simply to accept the fact that the restenosis rate is somewhat higher? I have a hard time advocating that another stent be placed in this circumstance.