Incidence and Clinical Significance of Poststent Optical Coherence Tomography Findings

Abstract

The aims of this study were (1) to evaluate the incidence of poststent findings detected by OCT from multicenter experience, (2) to correlate these poststent findings with 1-year device-oriented clinical end points (DoCEs), including cardiac death, target vessel-related myocardial infarction, target Background-Optical coherence tomography (OCT) was recently introduced to optimize percutaneous coronary intervention. However, the exact incidence and significance of poststent OCT findings are unknown. Methods and Results-A total of 900 lesions treated with 1001 stents in 786 patients who had postprocedure OCT imaging were analyzed to evaluate the incidence of poststent OCT findings and to identify the OCT predictors for device-oriented clinical end points, including cardiac death, target vessel-related myocardial infarction, target lesion revascularization, and stent thrombosis. Patients were followed up to 1 year. Stent edge dissection was detected in 28.7% of lesions, and incomplete stent apposition was detected in 39.1% of lesions. The incidences of smooth protrusion, disrupted fibrous tissue protrusion, and irregular protrusion were 92.9%, 61.0%, and 53.8%, respectively. Small minimal stent area, defined as a lesion with minimal stent area <5.0 mm 2 in a drug-eluting stent or <5.6 mm 2 in a bare metal stent, was observed in 40.4% of lesions. One-year device-oriented clinical end points occurred in 33 patients (4.5%). Following adjustment, irregular protrusion and small minimal stent area were independent OCT predictors of 1-year device-oriented clinical end points (P=0.003 and P=0.012, respectively). Conclusions-Abnormal

Predictors and Long‐Term Clinical Impact of Acute Stent Malapposition: An Assessment of Dual Antiplatelet Therapy With Drug‐Eluting Stents (ADAPT‐DES) Intravascular Ultrasound Substudy

“…Severe diameter stenosis and subsequent differences between the luminal diameter of the most stenotic segment and that of the reference vessel also increase the frequency of ASM 19. Heavily calcified lesions are prone to ASM, despite high‐pressure balloon dilation or rotational atherectomy 22, 23. In our study, there was a higher prevalence of ASM in the right coronary artery.…”

“…At 2‐year follow‐up combining BMS and paclitaxel‐eluting stents, there were no significant differences in MACE rates for patients with ASM (17.1%) versus no ASM. In the recent OCT studies of Prati et al21 (49.3% of ASM with stent to adjacent vessel distance >200 μm in 984 lesions of 832 patients) and Soeda et al22 (39.1% of ASM in 900 lesions of 786 patients), OCT‐detected ASM was not a predictor of 1‐year MACE.…”

“…Studies using optical coherence tomography (OCT) have reported a frequency of ASM that has ranged from 39.1% to 83.7%,19, 20, 21, 22 suggesting that it is ubiquitous after implantation if more sensitive methods are used to assess its frequency. Any finding seen in the majority of stents is of limited value in predicting adverse events.…”

SYNTAX Score and Pre- and Poststent Optical Coherence Tomography Findings in the Left Anterior Descending Coronary Artery in Patients With Stable Angina Pectoris

“…In post-PCI OCT, suboptimal stent deployment, including distal stent edge dissection, which was most frequent in our 3 rd tertile group, is associated with a higher risk of adverse events during follow up 25 . In recent study, Soeda et al observed that irregular protrusion was an independent predictor of device-oriented clinical endpoints at 1-year 10 . Combined with our results, the association of high SS and adverse cardiac events may be explained.…”

“…OCT evaluation before PCI included lipid rich plaque, lipid arc, lipid index, fibrous cap thickness (FCT), thincap fibroatheroma (TCFA), calcium deposits, and microchannels [7][8][9] . Post-stent OCT evaluation included mallaposition, stent edge dissection, intra-stent dissection, and irregular protrusion [10][11][12] . OCT images were analyzed by 2 investigators who were blinded to subject information, including SS.…”