Stent deployment in calcified lesions: Can we overcome calcific restraint with high‐pressure balloon inflations?

Although significant coronary artery (CA) calcification is believed to affect stent deployment, the exact impact on stent deployment after high‐pressure balloon inflations is unknown. Intracoronary intravascular examination (ICUS) was performed in 27 moderate‐severe calcified CA lesions before and after stent implantation. In case of unsatisfactory results (in‐stent area < 90%, minimal in‐stent diameter/maximal in‐stent diameter < 0.8), further inflations up to 20 atm guided by ICUS were applied. Initially, stent expansion was adequate in 10 stents (37%) and symmetric in 19 (70%). After inflation at 20 atm, stents with adequate expansion increased to 16 (59%, P = 0.0036), but stents with symmetry decreased to 13 (48%, P = 0.0045). Stent expansion was inversely correlated to the arc of calcium (r = ‐0.8, P < 0.0001). There were five patients with clinical restenosis at 6 months (18%). Increases in stent lumen area with high‐pressure balloon inflations in moderate‐severe calcified CA lesions are at the expense of symmetry. This may affect clinical restenosis. Cathet Cardiovasc Intervent 2001;52:164–172. © 2001 Wiley‐Liss, Inc.