Feasibility of biodegradable polymer everolimus-eluting stent overexpansion: the SYNOVER study

Seung Hun Lee; Yong-Kyu Lee; Joon Ho Ahn; Yongcheol Kim; Seongho Park; Donghyeon Joo; Kyung Hoo Cho; Min Chul Kim; Doo Sun Sim; Ju Han Kim; Youngkeun Ahn; Young Joon Hong

doi:10.1097/MCA.0000000000001529

Feasibility of biodegradable polymer everolimus-eluting stent overexpansion: the SYNOVER study

Coron Artery Dis. 2025 Apr 23. doi: 10.1097/MCA.0000000000001529. Online ahead of print.

Authors

Affiliations

¹ Department of Cardiology, Chonnam National University Hospital, Chonnam National University Medical School, Gwangju.
² Division of Cardiology, Department of Internal Medicine, Yongin Severance Hospital and Cardiovascular Center, Yonsei University College of Medicine, Yongin.
³ Division of Cardiology, Department of Internal Medicine, Wonkwang University Hospital, Iksan, South Korea.

PMID: 40265309
DOI: 10.1097/MCA.0000000000001529

Abstract

Background: Despite advancements in percutaneous coronary intervention (PCI), stent-related complications continue to occur, emphasizing the necessity for stent optimization. This study employed optical coherence tomography (OCT) to investigate the safety and efficacy of overexpanding the biodegradable polymer everolimus-eluting stent (SYNERGY; Boston Scientific, Marlborough, Massachusetts, USA) stent in large coronary arteries.

Methods: This single-center observational study enrolled patients with ischemic heart disease requiring stent placement in large coronary arteries (≥4.5 mm). The patients underwent PCI guided by OCT using SYNERGY stents, incorporating postdilation techniques to enhance expansion. Stent parameters were evaluated through OCT imaging. The primary endpoints focused on the maximum stent diameter and the maximum percentage of overexpansion. Secondary clinical outcomes, including death, myocardial infarction (MI), revascularization, stent thrombosis, cerebrovascular accidents (CVAs), and heart failure readmissions, were monitored with follow-ups at 1, 6, and 12 months, as well as annually thereafter.

Results: A total of 12 patients (8427 struts) were analyzed after successful PCI. OCT imaging showed adequate stent expansion, maximum stent diameter was 4.5 ± 0.2 mm, with a maximum expansion of 113.2 ± 4.1%), with no definite stent fractures or major edge dissections. During follow-up, one patient experienced an MI, but no stent thrombosis, target lesion revascularization, CVA, or death were reported.

Conclusion: Application of OCT-guided PCI with SYNERGY stents is safe and effective for treating large coronary arteries. It facilitates optimal stent expansion and yields favorable long-term outcomes. These results advocate for an expanded application of OCT-guided PCI in complex anatomical situations, showcasing the performance of SYNERGY stents in cases of excess expansion.

Keywords: acute coronary syndrome; large coronary artery; optical coherence tomography; percutaneous coronary intervention.

Abstract

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