Clinical Impact of Suboptimal Stenting and Residual Intrastent Plaque/Thrombus Protrusion in Patients With Acute Coronary Syndrome

Prati, Francesco; Romagnoli, Enrico; Gatto, Laura; Manna, Alessio La; Burzotta, Francesco; Limbruno, Ugo; Versaci, Francesco; Fabbiocchi, Franco; Giorgio, Alessandro Di; Marco, Valeria; Ramazzotti, Vito; Vito, Luca Di; Trani, Carlo; Porto, Italo; Boi, Alberto; Tavazzi, Luigi; Mintz, Gary S.

doi:10.1161/circinterventions.115.003726

Cited by 57 publications

(17 citation statements)

References 44 publications

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“…Although data are limited but not flow-limiting, small dissections have been found to have no impact on the clinical outcomes. Major stent edge dissections ( Figures 3H–J ) have been defined by their depth (disrupting at least the medial layer), their lateral extension (>60°), and their length (>2 mm) and have shown to be a predictor of poor outcomes ( 13 , 40 , 41 , 66 ). Intramural and extramural hematomas detected on OCT usually appear as edge stenosis on angiography and can be misdiagnosed as stent vessel mismatch or spasm.…”

Section: Oct For Pci Optimizationmentioning

confidence: 99%

Optical Coherence Tomography: An Eye Into the Coronary Artery

Gupta¹,

Shrivastava

Vijayvergiya

et al. 2022

Front. Cardiovasc. Med.

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Optical coherence tomography (OCT) is slowly but surely gaining a foothold in the hands of interventional cardiologists. Intraluminal and transmural contents of the coronary arteries are no longer elusive to the cardiologist's probing eye. Although the graduation of an interventionalist in imaging techniques right from naked eye angiographies to ultrasound-based coronary sonographies to the modern light-based OCT has been slow, with the increasing regularity of complex coronary cases in practice, such a transition is inevitable. Although intravascular ultrasound (IVUS) due to its robust clinical data has been the preferred imaging modality in recent years, OCT provides a distinct upgrade over it in many imaging and procedural aspects. Better image resolution, accurate estimation of the calcified lesion, and better evaluation of acute and chronic stent failure are the distinct advantages of OCT over IVUS. Despite the obvious imaging advantages of OCT, its clinical impact remains subdued. However, upcoming newer trials and data have been encouraging for expanding the use of OCT to wider indications in clinical utility. During percutaneous coronary intervention (PCI), OCT provides the detailed information (dissection, tissue prolapse, thrombi, and incomplete stent apposition) required for optimal stent deployment, which is the key to successfully reducing the major adverse cardiovascular event (MACE) and stent-related morbidities. The increasing use of OCT in complex bifurcation stenting involving the left main (LM) is being studied. Also, the traditional pitfalls of OCT, such as additional contrast load for image acquisition and stenting involving the ostial and proximal LM, have also been overcome recently. In this review, we discuss the interpretation of OCT images and its clinical impact on the outcome of procedures along with current barriers to its use and newer paradigms in which OCT is starting to become a promising tool for the interventionalist and what can be expected for the immediate future in the imaging world.

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Section: Oct For Pci Optimizationmentioning

confidence: 99%

Optical Coherence Tomography: An Eye Into the Coronary Artery

Gupta¹,

Shrivastava

Vijayvergiya

et al. 2022

Front. Cardiovasc. Med.

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show abstract

“…In this event, it should be corrected by using a larger diameter balloon. In case of thrombosis within the stent or tissue prolapse inside the stent, the additional stent is required only if the effective lumen area is reduced, or it is causing acute coronary syndrome (ACS) [52][53][54]. During stenting, myonecrosis and plaque rupture can occur if TCFAs are detected [55].…”

Section: Goals Of Stent Optimizationmentioning

confidence: 99%

Intracoronary Imaging-Can It Make Difference in State of the Art PCI?

Mody¹

2022

J Cardiol Cardiovasc Res

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There is an anatomy and there is an anatomy. Angiography is a rough method used for estimating dimensions. By completing the intervention with intracoronary imaging, one can directly characterize lesion composition, elucidate pathophysiology, and luminal size measurement. This review describes patients and lesions where imaging may be most beneficial, along with up-to-date evidence of the impact induced on cardiovascular events by the intracoronary imaging. It summarizes the importance of organizing procedural strategies and the use of various imaging methods such as optical coherence tomography or intravascular ultrasound for percutaneous coronary intervention (PCI) to improve stent optimization. Further, various advantages and disadvantages are associated with the use of imaging methods OCT and IVUS in the management of PCI and the elucidation of the causes of stent failure are discussed. It also explains the use of OCT or IVUS in various severe pathological conditions such as severe kidney disease (CKD), left main disease, bifurcation lesion, acute coronary syndrome (ACS), and patients present with high bleeding risk. It also describes diagnostic imaging of patients with vulnerable plaques. We will also talk about various other advanced imaging methods such as investigational Micro-optical Coherence Tomography and near-infrared spectroscopy (NIRS).

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“…The presence of at least one of the aforementioned shows worse outcomes (17.9% vs. 4.8% cardiac death, target vessel MI, and target lesion revascularization) during the follow-up period (median 345 days). Residual intra-stent plaque/thrombus protrusion (500 µm thickness cut-off) was an independent predictor for a three-fold higher risk of a worse outcome (as previously defined) [ 62 ].…”

Section: Anatomical Features and Revascularizationmentioning

confidence: 99%

Risk Stratification of Patients with Acute Coronary Syndrome

Bauer

Toušek

2021

JCM

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Defining the risk factors affecting the prognosis of patients with acute coronary syndrome (ACS) has been a challenge. Many individual biomarkers and risk scores that predict outcomes during different periods following ACS have been proposed. This review evaluates known outcome predictors supported by clinical data in light of the development of new treatment strategies for ACS patients during the last three decades.

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Clinical Impact of Suboptimal Stenting and Residual Intrastent Plaque/Thrombus Protrusion in Patients With Acute Coronary Syndrome

Cited by 57 publications

References 44 publications

Optical Coherence Tomography: An Eye Into the Coronary Artery

Optical Coherence Tomography: An Eye Into the Coronary Artery

Intracoronary Imaging-Can It Make Difference in State of the Art PCI?

Risk Stratification of Patients with Acute Coronary Syndrome

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