Page 17 - Journal of Structural Heart Disease Volume 3, Issue 6

173 Original Research Article
Figure 6. Vessel wall injury and endothelialization of blood vessels after pre-stenting compared with single stent implantation. Panels A, B, and C. Intentional stent fracture with pre-stenting caused only minimal vessel wall injury and did not result in transmural vessel injury or damage of surrounding soft tissue. Panel A. Localized dissection of the tunica media in a stented vessel immediately after stent implantation and lack of external protrusion of stent struts. Panel B. High-magni cation image showing the extent of dis- section and intramural hemorrhage immediately after stent placement. Panel C. Macroscopic picture showing no damage to the ex- ternal surface of blood vessels despite the size discrepancy of stented segments. Panels D, E, and F. Pre-stenting allowed appropriate endothelialization and minimal vessel wall injury 2 months after stent placement. Panel D. Mid-term (i.e., 2 month) follow-up showed mild intimal and medial thickening in response to stent placement, no intraluminal protrusion of stent struts, and no dissection or pathologic vessel dilation. Panels E and F. High-magni cation images showing almost complete endothelial coverage over stent struts 2 months after implantation. Panel G. Single stent implantation with intentional stent fracture (i.e., unzipping without pre-stent- ing) led to incomplete endothelialization due to intraluminal stent strut protrusion and decreased vessel lumen cross-sectional area. Panels H and I. High-magni cation images showing stent strut protrusion without endothelial coverage. Grey bars in A, D, and G = 3 mm; black bars in B, E, and H = 0.5 mm and in F and I = 0.2 mm. Black arrowheads indicate endothelial coverage over stent struts, and black arrows point to bare metal struts protruding into the vessel lumen.
Bratincsák A. et al. Pre-Stenting with Intentional Stent Fracture