2021 Volume 85 Issue 4 Pages 399-
Evaluations of endovascular therapy (EVT) with novel self-expanding interwoven nitinol stents (Supera; Abbott Vascular, Chicago, IL, USA) have shown that these stents are highly flexible and have high radial resistive strength.1 However, stent invagination has recently been reported following inadequate deployment.2
A 72-year-old woman underwent EVT for an ischemic ulcer in the right lower limb. After predilatation with a non-compliant balloon (18 atm, 2 min, 3 times, 5.0 mm×80.0 mm), a Supera stent (5.5 mm×150.0 mm) was implanted in the severely calcified right femoropopliteal artery. At the mid-portion of the stent, stent invagination occurred during deployment. After high-pressure balloon dilatation (30 atm, 6.0 mm×60 mm), final angiography revealed acceptable blood flow to below the knee, but stent invagination was unchanged. The patient’s ulcer healed completely in 2 months, but an ulcer recurred in the right limb at 6 months. Angiography showed restenosis at the mid-portion of the stent, corresponding to the stent invagination. We evaluated the lesion using 3 different intravascular imaging modalities: intravascular ultrasound, optical coherence tomography (OCT), and angioscopy. OCT showed characteristics of homogeneous tissue and angioscopy revealed a white plaque on the image at the stent invagination. The struts had a “spider’s web” appearance at the stent invagination and were almost totally covered with large amounts of neointima, leading to lumen loss (Figure A-1–4; Supplementary Movies 1,2).
Angiography at initial endovascular therapy (EVT) and angiography, intravascular ultrasound (IVUS), optical coherence tomography (OCT), and angioscopy at repeated (re-)EVT. (A-1–3) There were large amounts of neointima at the stent invagination (A). (A-4) Schematic representation.
This is the first report evaluating restenosis at the stent invagination of a self-expanding interwoven nitinol stent using multiple imaging modalities. These findings suggest that stent invagination may accelerate neointimal proliferation with a risk of late stent lumen loss.
M.I. is a member of Circulation Journal’s Editorial Team.
All authors have nothing to disclose.
Supplementary Movie 1. Intravascular ultrasound at re-endovascular therapy.
Supplementary Movie 2. Optical coherence tomography at re-endovascular therapy.
Please find supplementary file(s);
http://dx.doi.org/10.1253/circj.CJ-20-1278
