What is the largest diameter of a coronary artery stent?

Largest Diameter of Coronary Artery Stents

The largest commercially available coronary artery stents have a maximum diameter of approximately 6.0 mm after post-dilation, though most standard platforms are manufactured with nominal diameters up to 4.0-4.5 mm.

Standard Stent Sizing Parameters

Nominal Diameter Range

• Most coronary stents are manufactured with nominal diameters ranging from 2.25 mm to 4.0 mm 1
• Clinical trials have typically included vessels with reference diameters between 2.5-4.0 mm 1
• The TAXUS-IV trial specifically included vessels 2.5 to 3.75 mm in diameter 1

Maximum Achievable Diameters with Post-Dilation

• When 4.0 mm nominal stents undergo aggressive post-dilation with 6.0 mm balloons at 14 atmospheres, maximum inner lumen diameters achieved are:
  • Taxus stent: 6.0 mm 2
  • BioMatrix stent: 5.9 mm 2
  • Cypher stent: 5.8 mm 2
  • PROMUS Element: 5.7 mm 2
  • XIENCE Prime: 5.6 mm 2
  • Resolute Integrity: 5.4 mm 2

Clinical Context for Large Vessel Stenting

Vessel Size Considerations

• Stents ≥3.50 mm diameter are classified as "large coronary stents" in clinical practice 3
• In the EXAMINATION trial, large stents (≥3.50 mm) were used in 45.9% of ST-elevation myocardial infarction cases 3
• Vessels ≥3 mm diameter have acceptable safety profiles for stenting in both stable and unstable angina 4

Left Main Applications

• Left main coronary artery stenting frequently requires deployment across vessels with marked diameter disparities 2
• Knowledge of maximal expansion capacity is critical for left main bifurcation treatment to ensure adequate strut apposition after post-dilation 2
• IVUS guidance is recommended (Class IIb) for left main stenting, with target minimal lumen area >5.0 mm² or ≥90% of distal reference 5

Important Caveats and Limitations

Stent Thrombosis Risk

• Stent thrombosis is significantly associated with small vessel size (p<0.001), with most thromboses occurring in vessels <3 mm diameter 4
• Coronary CTA has low accuracy for diagnosing in-stent restenosis, particularly in stents smaller than 3.0 mm diameter 1

Structural Deformation with Oversizing

• Extensive post-dilation beyond nominal diameter causes significant deformations in cell opening and crown expansion 2
• These deformations vary by stent design and may alter the functional ability to scaffold lesions and prevent restenosis 2
• Stent selection based on workhorse design is critical when overexpansion is required 2

Long-Term Outcomes

• Drug-eluting stents show improved efficacy over bare-metal stents regardless of vessel size, including in large vessels 3
• In vessels 4.0-4.4 mm diameter, no significant difference in major adverse cardiovascular events exists between 4 mm DES, 4 mm BMS, or 3 mm DES with 4 mm post-dilation 6
• Late luminal renarrowing beyond 4 years is common even in successfully stented vessels, demonstrating need for continued surveillance 7