Clinical and Biomechanical Behavior of a Platinum-Chromium Stent Platform in a Large All-Comer Single-Center Population: Insights From the Novara-PROMETEUS Registry

Aims. Longitudinal deformation has been described as a new complication affecting new-generation thin-strut coronary stents. Benchmark tests have suggested that the platinum-chromium (PtCr) Element coronary stent platform (Boston Scientific) might present increased susceptibility to this complication. Our study assessed the incidence of longitudinal stent deformation in a large single-center study population. Methods and Results. A total of 337 consecutive Promus Element PtCr stents deployed in an all-comer population underwent quantitative coronary angiography (QCA) analysis. Postdeployment QCA measured/nominal stent length ratio (SLR) was considered as a surrogate estimate of longitudinal stent deformation and averaged 0.95 +/- 0.04 in the entire population. This small postdeployment reduction of stent length had no clinical relevance, leading to 3 cases (0.9%) of trivial geographical miss, which did not require further interventions. Plaque prolapse through the stent struts was observed in 19 cases (5.6%). Only 1 case of typical "concertina" effect (0.3%) complicated an ostial stenosis treatment requiring deployment of a second stent, while in 3 cases (0.9%), stent struts adapted to severely tortuous and calcified vessels mimicked longitudinal stent deformation, without further complications. Multiple regression analysis demonstrated a significant correlation between need for predilation and lower SLR values, while postdilation independently predicted higher SLR. Conclusions. Systematic QCA analysis of a large single-center all-comers PCI population treated with PtCr stents failed to detect any clinically relevant longitudinal stent deformation. Complex lesions needing predilation were associated with a reduced SLR; conversely, postdilation was associated with QCA stent measures close to nominal.