Coronary Stent Healing in Cancer Patients—An Optical Coherence Tomography Perspective

Abstract

Objective: This study assessed stent healing patterns and cardiovascular outcomes by optical coherence tomography (OCT) in cancer patients after drug-eluting stent (DES) placement.Background: Cancer treatment, owing to its cytotoxic and antiproliferative effects, could delay stent healing and increase stent thrombosis risk, especially when dual antiplatelet therapy (DAPT) is discontinued early for oncological treatment. OCT can assess stent endothelialization and other healing parameters, which may provide clinical guidance in these challenging scenarios.Methods: This single-center retrospective study enrolled all cancer patients who underwent OCT for assessment of vascular healing patterns after prior DES placement from November 2009 to November 2018. Primary study endpoints were stent healing parameters, including stent coverage, apposition, degree of expansion, neointimal hyperplasia heterogeneity, in-stent restenosis, stent thrombosis, and overall survival (OS).Results: A total of 67 patients were included in this study. Mean time between DES placement and OCT evaluation was 154 ± 82 days. Stent healing matched published values for DES in non-cancer patients (P ≥ 0.063). At 1 year, the OS was 86% (95% confidence interval [CI]: 78–96%) with 0% incidence of acute coronary syndrome. Advanced cancers and active chemotherapies were associated with inferior OS (P = 0.024, hazard ratio [HR]: 3.50, 95% CI: 1.18–10.42 and P = 0.026, HR: 2.65, 95% CI: 1.13–6.22, respectively), while stent healing parameters were unassociated with OS. Forty-one patients (61%) had DAPT duration ≤6 months.Conclusions: Stent healing of contemporary DES appears similar in cancer and non-cancer patients. Cardiovascular risk of cancer patients after DES placement can be managed to facilitate timely cancer therapies, as the underlying malignancy and active chemotherapy ultimately determine survival.

Radiation Treatment Mechanisms of Cardiotoxicity: A Systematic Review

“…By utilizing this technology, it has been able to obtain important measurements of stenotic lesions, minimal luminal area (MLA), and characteristics of atherosclerotic plaques, but also calcification and thrombus formation in cancer patients with coronary artery disease and may guide more appropriate therapeutic management. After percutaneous coronary interventions, further data acquisitions on stent apposition and follow-up studies of in-stent restenosis add important improvements to advanced coronary interventions since lesions of coronary patients may be complex and advanced interventional techniques may be used for therapeutic management (rotablation techniques, shock wave balloons, intravascular lithotripsy) [ 35 ]. OCT may be additionally a very useful imaging modality for treatment decisions on dual antiplatelet therapy discontinuation after percutaneous coronary interventions [ 36 ].…”

Percutaneous coronary intervention in patients with cancer using bare metal stents compared to drug-eluting stents

“…A study using OCT to evaluate stent healing after DES placement showed adequate stent healing in cancer patients despite a shorter course of DAPT (< 6 months) in 61% of them. Findings were matched with stent healing value for DES in non-cancer patients ( 15 ).…”

Coronary Revascularization in Patients With Cancer

“…A single-center prospective study in cancer patients with a recently placed DES (within 1–12 months), who needed early discontinuation of their DAPT, showed that optical coherence tomography (OCT) imaging can be used to identify those at low risk for discontinuation and can thus proceed with their cancer-related surgery or procedures [ 86 ]. A similar study using OCT to evaluate stent healing after DES placement showed adequate stent healing in cancer patients, despite a short course of DAPT (< 6 months) in over 61% of patients [ 87 ].…”