LM Stent Longitudinal Deformation

Case Conrner> LM Stent Longit. . .

LM Stent Longitudinal Deformation Shatha Alalawi, MD

Interventional Cardiologist King Abdullah Medical Complex Jeddah, KSA

Case Presentation

  • 73 years old gentleman , known case of hypertension and Parkinson’s disease
  • Came to ER with a typical chest pain for 1 week duration
  • Admitted as a case of NSTEMI
  • ECG : normal sinus rhythm with ST segment depression in inferior leads
  • ECHOCARDIOGRAPHY : Normal LV wall thickness , EF ~50% with RWMA in LAD and RCA territories
  • Positive cardiac biomarkers
  • All other labs within normal limits

Diagnostic Coronary Angiography

Multidisciplinary Discussion 

  • Multidisciplinary meeting decision as follow:✔ PCI to PDA/PLB✔Staged IVUS guided PCI to LM/LAD using Intravascular Lithotripsy (IVL)


  • Drug Eluting Stent to PLB
  • Drug Coated Balloon to PDA resulted in mild dissection with TIMI III flow

IVUS guided PCI to LM/LAD using IVL


In the absence of a healthy landing zone at the Ostial LAD we opted to proceed for PCI LAD to the LM

IVUS guided PCI to LM/LAD using IVL

During post dilation stent boost showed crimbed proximal part of stent with a possible separated struts at the site of calcified region near the overlapped stent and LCX ostium



Uncovered segment was treated with additional stent 

IVUS POST deployment of additional stent

Is it Stent Fracture or Pseudofracture (longitudinal stent deformation)

Stent Fracture

Defined as separation of stent struts (partial or complete)

Stent Pseudofracture (longitudinal stent deformation)

  • Defined as distortion or shortening of a stent in the longitudinal axis following successful stent deployment
  • This Shortening causing a longitudinal stent deformation and tissue prolapse which might lead stent thrombosis and uneven drug delivery leads to late ISR


Stent fracture (SF ) and Psudofracture (LSD) are associated with increased risk of TLR ( ISR and stent thrombosis)

Risk factors for SF Include

  • Stent type /procedural related (Stent type ie,sirolimus stent , Long stent, Overlapping stent, Excessive pressure during stent deployment)
  • Lesion related ( RCA stenting , Calcification, ostial and bifurcation)
  • Patient related factors such as hypertension and chronic kidney disease

Longitudinal Stent Deformation (LSD) is a procedural complication occurs with post dilation with non-compliant balloon, a guide catheter or a device such as an intravascular ultrasound catheter

  • Some stent designs have a connection to LSD.
  • Stent performance is affected by a number of factors, including the flexibility of the crimped and deployed stents, their trackability, scaffolding, radio-opacity, longitudinal and radial strengths, and their recoil.
  • The improvement of one stent feature may, however, have a negative impact on other stent attributes.
  • In order to maximize flexibility and side-branch access, for instance, fewer connectors were used between the hoops, which decreased longitudinal strength and increased the risk of longitudinal distortion.
  • LSD can be caused by the most popular stent platform:
  1. Platform Element (Boston Scientific, Natick, Massachusetts, USA)

2.(Medtronic Inc., Minneapolis, Minnesota, USA) driver platform

3.The United States’ XIENCE V (Abbott Vascular, Santa Clara, CA)

Mechanism of LSD and associated risk 

  • An angioplasty balloon or guide catheter exerts pressure to a specific location on the proximal circumference of the stent (most frequently the proximal ends, but it can also happen at the body or distal end), especially when the catheter is not coaxial with the stent.
  • It results in stent hoops being pushed together, deformation of the proximal end of the stent, lumen obstruction, and stent malapposition.
  • The appearance has been compared to that of a concertina or accordion, with the struts compressed, squeezed, or pushed together, or with stent shrinking, folding, or wrinkling

Mechanism of LSD and associated risk 

  • In addition to luminal obstruction , longitudinally deformed stents have been linked to an increased risk of:

➢In stent thrombosis

➢Instent restenosis  (malapposition results in Inconsistent drug distribution )

➢Uncovered segment require additional stenting or revascularization surgery


  • Looking back, we found that the stent used was a Promus stent.
  • In our case we additionally deployed a Resolute Onyx stent with good angiographic and IVUS results


  • The likelihood of Target Vessel Revascularization (TVR) is increased by both stent fracture (SF) and pseudofracture (LSD).
  • Strong grounds for suspecting LSD when passing equipment (such as a balloon) is difficult.
  • LSD Additional stenting is necessary for the uncovered segment
  • To choose the right stent and achieve the best results, the operator and CATHLAB team should be knowledgeable about the kind and qualities of stents.


  • Hanratty C, Walsh S. Longitudinal compression: a “new” complication with modern coronary stent platforms-time to think beyond deliverability.Eurointerv. 2011
  • Williams PD, Mamas MA, Morgan KP, El-Omar M, Clarke B, Bainbridge A, Fath-Ordoubadi F, Fraser DG. Longitudinal stent deformation: a retrospective analysis of frequency and mechanisms.EuroIntervention. 2012
  • John A. Ormiston, Bruce Webber, Ben Ubod, Jonathon White, and Mark W.I. Webster, Stent Longitudinal Strength Assessed Using Point Compression. Circulation: Cardiovascular Interventions, February 2014
  • Mamas MA, Williams PD. Longitudinal stent deformation: insights on mechanisms, treatments and outcomes from the Food and Drug Administration Manufacturer and User Facility Device Experience database.EuroIntervention. 2012
LM Stent Longitudinal Deformation
Scroll to top