Incidences, Predictors, and Clinical Outcomes of Acute and Late Stent Malapposition Detected by Optical Coherence Tomography After Drug-Eluting Stent Implantation

Abstract

5However, optical coherence tomography (OCT) with a higher resolution (12-18 μm) may detect stent malapposition with greater accuracy. There are limited data on detection of acute and late stent malapposition by OCT in small sample sizes. Therefore, we investigated the incidences, predictors, and clinical outcomes of acute and late stent malapposition detected by OCT in a large number of patients who received DESs. Editorial see p 6 Methods Study PopulationPatients who received implantation of DESs for de novo coronary lesions between January 2009 and December 2011 with poststent and follow-up OCT were identified from the OCT registry database of our institute. Exclusion criteria included the following (1) the DES was implanted for left main coronary disease, (2) there were overlapping DESs implanted in the lesion, (3) the clinical follow-up period after DES implantation was <1 year, (4) follow-up OCT was performed >1 year after DES implantation, and (5) the OCT image had poor quality.Background-We investigated the incidences, predictors, and clinical outcomes of acute and late stent malapposition detected by optical coherence tomography (OCT) after drug-eluting stent implantation. Methods and Results-We analyzed the OCT images from 351 patients with 356 lesions who received poststent and followup OCT examinations. Acute stent malapposition was observed in 62% of lesions. Approximately half of the acute stent malappositions were located within the edges of the stents. Severe diameter stenosis, calcified lesions, and long stents were independent predictors of acute stent malapposition. Follow-up OCT examinations were performed 175±60 days after drug-eluting stent implantation. Thirty-one percent of lesions with acute stent malapposition remained malapposed (late-persistent stent malapposition) and were typically (72%) located within the edges of the stent. The location within the stent edges and the volume of acute stent malapposition were independent predictors of late-persistent stent malapposition. Acute stent malapposition with a volume >2.56 mm 3 differentiated late-persistent stent malapposition from resolved acute stent malapposition. Late-acquired stent malapposition was detected in 15% of all lesions and was usually (61%) located within the stent body. Late-acquired stent malapposition was more frequently associated with plaque/thrombus prolapse on poststent OCT images (70% versus 42%; P<0.001). Clinical events, including cardiovascular death, nonfatal myocardial infarction, and stent thrombosis, did not occur in patients with late stent malapposition during the follow-up period of 28.6±10.3 months after drug-eluting stent implantation. Conclusions-Acute, late-persistent, and late-acquired stent malapposition had relatively high incidences but different predictors. The clinical outcome of stent malapposition was favorable. (Circ Cardiovasc Interv. 2014;7:88-96.)

Mechanisms of stent thrombosis: insights from optical coherence tomography

“…In intravascular ultrasound study investigating the long-term prognosis of late stent malapposition that was detected at 6 months after DES implantation, the stent malapposition was not associated with any major adverse cardiac events during a subsequent 10-month follow-up (4). A similar finding was observed in an OCT study, in which adverse cardiac events did not occur in patients with late stent malapposition during follow-up of mean 28 months after DES implantation (5). Contrary to these studies, crosssectional OCT studies showed that the malapposition was a leading cause of early, late, or very late ST (3,6).…”

“…Contrary to these studies, crosssectional OCT studies showed that the malapposition was a leading cause of early, late, or very late ST (3,6). These discrepancies were partly explained by the finding that stent malapposition could be spontaneously resolved over time (5,7). As a determinant for the resolution of stent malapposition, the distance between malapposed strut and vessel wall was proposed: the greater the distance, the more persistent the malapposition (8).…”

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

“…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.…”

“…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.…”

Optical Coherence Tomography for Study of <i>In Vivo</i> Pathobiology and for Optimization of Percutaneous Coronary Intervention

“…3B) may be related to persistent malapposition, 75) or delayed neointimal coverage, 78) but small incomplete stent apposition is not related to clinical events. [73][74][75][76]79) Tissue protrusion (Fig. 3C) may be related to neointimal hyperplasia, 80) but does not affect the occurrence of clinical events either.…”