SPC365

Stent performance in the spotlight: simulation using 3D-printed bifurcation models

Session: SESSÃO DE COMUNICAÇÕES ORAIS 20 - PRÉMIO MELHOR COMUNICAÇÃO ORAL
Speaker: Catarina Simões De Oliveira

Congress: CPC 2025
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Session Type: Comunicações Orais
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Authors: Catarina Simões De Oliveira; Miguel Raposo; Diogo Ferreira; Daniel Cazeiro; Tiago Rodrigues; Miguel Nobre Menezes; Helena Santiago; Helana Correia; Manuel F.C.Pereira; Fausto J. Pinto; João Silva Marques
<p style="text-align:justify"><span style="font-size:12pt"><span style="font-family:Calibri,sans-serif"><strong><span style="font-size:11.0pt"><span style="font-family:&quot;Arial&quot;,sans-serif">Introduction:</span></span></strong><span style="font-size:11.0pt"><span style="font-family:&quot;Arial&quot;,sans-serif"> The treatment of ostial lesions in the left anterior descending artery (LAD) poses significant challenges. Left main crossover stenting tests the limits of contemporary drug eluting stents (DES). There is a gap in evidence for guiding stent selection in this context. </span></span></span></span></p>

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<p style="text-align:justify"><span style="font-size:12pt"><span style="font-family:Calibri,sans-serif"><strong><span style="font-size:11.0pt"><span style="font-family:&quot;Arial&quot;,sans-serif">Aim</span></span></strong><span style="font-size:11.0pt"><span style="font-family:&quot;Arial&quot;,sans-serif">: This study sought to compare the performance of different DES in a standardized left main bifurcation lesion (Medina 0,1,0) using 3D-printing and a realistic simulation environment (<strong>Image A and B</strong>).</span></span></span></span></p>

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<p style="text-align:justify"><span style="font-size:12pt"><span style="font-family:Calibri,sans-serif"><strong><span style="font-size:11.0pt"><span style="font-family:&quot;Arial&quot;,sans-serif">Methods:</span></span></strong><span style="font-size:11.0pt"><span style="font-family:&quot;Arial&quot;,sans-serif"> A realistic left main anatomy with an eccentric ostial LAD lesion was replicated using 3D-printing with flexible resin. Tests were performed using a realistic simulator with pulsatile flow in the cath lab. Five 3.5mm DES (Xience Skypoint, Onyx Frontier, Synergy, Orsiro Mission and Ultimaster Tansei) were implanted in similar 3D-printed models using a standardized protocol following European Bifurcation Club recommendations that included final POT using a 6mm balloon (<strong>Image C</strong>). Angiography, OCT and IVUS runs were acquired at each procedural step and images were blindly reviewed and analyzed offline (<strong>Image D</strong>). Micro-CT was used after each intervention for comprehensive analysis of DES performance (<strong>Image E</strong>).</span></span></span></span></p>

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<p style="text-align:justify"><span style="font-size:12pt"><span style="font-family:Calibri,sans-serif"><strong><span style="font-size:11.0pt"><span style="font-family:&quot;Arial&quot;,sans-serif">Results: </span></span></strong><span style="font-size:11.0pt"><span style="font-family:&quot;Arial&quot;,sans-serif">Micro-CT analysis revealed that stent expansion at the ostial lesion was higher using Ultimaster and lower with Synergy. Xience achieved the highest and Synergy the lowest expansion in the left main after POT. Observed overexpansion was 147% of the nominal stent diameter, on average. Importantly, all stents kept structural integrity. Accordingly, stent malapposition after POT assessed by OCT was lower for Ultimaster and Xience stents and higher for Synergy. On micro-CT, the stent cell area at the side-branch showed substantial variation (3.3-13.1mm<sup>2</sup>) being lower for Synergy and higher for Ultimaster.</span></span></span></span></p>

<p style="text-align:justify"><span style="font-size:12pt"><span style="font-family:Calibri,sans-serif"><span style="font-size:11.0pt"><span style="font-family:&quot;Arial&quot;,sans-serif">Regarding stent length, Xience, Orsiro and Onyx elongated after POT (4.3mm, 1.6mm and 1.5mm, respectively) and Ultimaster shortened (-1.5mm). Synergy showed no significant length change.</span></span></span></span></p>

<p style="text-align:justify"><span style="font-size:12pt"><span style="font-family:Calibri,sans-serif"><span style="font-size:11.0pt"><span style="font-family:&quot;Arial&quot;,sans-serif">When employing micro-CT as the benchmark for evaluating intravascular imaging techniques in analyzing the outcomes of bifurcation interventions, OCT demonstrated superior performance compared to IVUS. There was a strong correlation between OCT and micro-CT stent measurements in distal left main and at the ostial stenosis (distal left main area p=0.037, r=0.9; stenosis stent area p=0.026, r=0.92).</span></span></span></span></p>

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<p style="text-align:justify"><span style="font-size:12pt"><span style="font-family:Calibri,sans-serif"><strong><span style="font-size:11.0pt"><span style="font-family:&quot;Arial&quot;,sans-serif">Conclusion</span></span></strong><span style="font-size:11.0pt"><span style="font-family:&quot;Arial&quot;,sans-serif">: This study underscores the potential influence of DES platform selection on the outcomes of bifurcation interventions, particularly when there is a significant size disparity between the distal and proximal landing zones, as well as complex ostial stenosis. The integration of 3D-printed anatomical models in simulation testing marks a significant leap forward offering a novel pathway to enhance the safety, efficacy, and personalization of interventions.</span></span></span></span></p>