Intravascular Imaging for Guiding In‐Stent Restenosis and Stent Thrombosis Therapy

Abstract

Advances in stent technology and the design of endovascular devices with thinner struts, anti‐inflammatory and antithrombotic polymers, and better drug kinetics have enhanced the safety and efficacy of the second‐generation drug‐eluting stents and broadened their use in the therapy of high‐risk patients and complex anatomies. However, despite these developments, in‐stent restenosis and stent thrombosis remain the Achilles' heel of percutaneous coronary intervention, with their cumulative incidence reaching up to 10% at 5 years following percutaneous coronary intervention. The treatment of stent failure poses challenges and is associated with a worse prognosis than conventional percutaneous coronary intervention. Several studies have recently highlighted the value of intravascular imaging in identifying causes of stent failure, underscored its role in treatment planning, and registries have shown that its use may be associated with better clinical outcomes. The present review aims to summarize the evidence in the field; it discusses the value of intravascular imaging in identifying the mechanisms of in‐stent restenosis and stent thrombosis in assessing the morphological characteristics of neointima tissue that appears to determine long‐term outcomes in evaluating procedural results, and presents the findings of studies supporting its value in guiding therapy in stent failure.

Evaluation and management of drug-eluting stent in-stent restenosis

“…1). On the other hand, with a greater axial resolution of 15 μm, OCT offers more reliable characterization of lumen neointima interface and neointima morphology, in addition to enabling visualization of stent architecture, apposition and distribution [21,26,27 ▪ ]. Neoatherosclerosis, seen as hypocellular intima with high proteoglycan or fibrin content is best characterized on OCT as a layered, heterogenous appearance [28] (Fig.…”

Effect of serum uric acid on prognosis of drug-eluting stent implantation for patients with coronary bifurcated lesions

“…However, whether it is drug balloon dilation (DCB), BMS implantation, or the most widely used DES implantation used in the treatment, there is always a risk of vascular restenosis after surgery, with DES having the lowest probability of ISR, but still reaching 5% -10% 5 . The main mechanism of ISR is proliferation of vascular intima, and surgical procedures such as balloon dilation, stent placement, and wire guiding operations can cause endothelial damage, leading to local thrombosis, in ammatory reactions, excessive proliferation of vascular intima, vascular wall remodeling, and nal occurrence of ISR [6][7][8] , increasing the incidence of major adverse cardiovascular events and seriously affecting the prognosis of PCI patients. Some risk factors may exist for the prognosis of coronary heart disease PCI, including lesion location, stent types, surgical pro ciency, age, smoking, serum lipidemia, diabetes mellitus, hypertension, serum uric acid, C-reactive protein, and D-dimer [7][8][9][10][11][12][13] .…”

Depth‐resolved method for attenuation coefficient calculation from optical coherence tomography data for improved biological structure visualization

“…Optical coherence tomography (OCT) is one of the most promising, innovative, and rapidly emerging intraoperative imaging modalities. Over the past decades, this technology has been successfully applied in various fields of medicine from ophthalmology to endovascular surgery [1][2][3][4]. OCT is most often used to visualize layered biological objects such as the retina, mucous membranes, and skin.…”