Stent Creep – Cardiology MCQ

Stent Creep is:
a) Creeping of neointimal proliferation into bare metal stent
b) Telescoping of stent struts due to concertina effect
c) Seen in Hancock bioprosthesis is due to inward bending of the stent struts
d) None of the above
Correct Answer: c) Seen in Hancock bioprosthesis is due to inward bending of the stent struts
“Stent Creep” seen in Hancock bioprosthesis is due to inward bending of the stent struts [1]. It is not obvious on echocardiographic imaging, but increases the transvalvular gradient as measured by Doppler echocardiography. Stent creep tends to increase with time after implantation [2]. It is due to an ultrastructural deformity polypropylene used in the valve stent [3].
Valve-in-valve tanscatheter aortic valve implantation has been used to treat bioprosthetic failure due to stent creep [4].
References

1. Schoen FJ, Schulman LJ, Cohn LH. Quantitative anatomic analysis of “stent creep” of explanted Hancock standard porcine bioprostheses used for cardiac valve replacement. Am J Cardiol. 1985 Jul 1;56(1):110-4.
2. Akiyama K, Sawatani O, Imamura E, Endo M, Hashimoto A, Koyanagi H. Clinical study of “stent creep” in porcine bioprosthesis. Nihon Geka Gakkai Zasshi. 1988 May;89(5):747-51.
3. Valente M, Bortolotti U, Thiene G, Arbustini E, Milano A, Mazzucco A, Gallucci V. Post bending of the polypropylene flexible stent in mitral Hancock bioprostheses. Eur J Cardiothorac Surg. 1987;1(3):134-8.
4. Attia R, Papalexopoulou N, Hancock J, Young C, Thomas M, Bapat V. Successful treatment of failing biological prosthesis because of “Stent creep” with valve-in-valve transcatheter aortic valve implantation. Catheter Cardiovasc Interv. 2015 Aug;86(2):E119-25.