Mechanisms of stent thrombosis: insights from optical coherence tomography

Lee, Seung Yul; Hong, Myeong Ki

doi:10.21037/jtd.2016.04.31

Cited by 6 publications

(6 citation statements)

References 17 publications

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“…An astonishing event is that even an allergic reaction to clopidogrel (41), the drug that is given to prevent stent thrombosis, itself has induced stent thrombosis (42)! However, others (43) have emphasized the role of stent malapposition and under-expansion as prominent mechanisms for early stent thrombosis and have greatly recommended the use of intravascular imaging in order to achieve the optimal stent expansion, and to minimize large stent malapposition.…”

Section: Causes Of Stent Thrombosismentioning

confidence: 99%

Thrombotic responses to coronary stents, bioresorbable scaffolds and the Kounis hypersensitivity-associated acute thrombotic syndrome

et al. 2017

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Percutaneous transluminal coronary angioplasty with coronary stent implantation is a lifesaving medical procedure that has become, nowadays, the most frequent performed therapeutic procedure in medicine. Plain balloon angioplasty, bare metal stents, first and second generation drug-eluting stents, bioresorbable and bioabsorbable scaffolds have offered diachronically a great advance against coronary artery disease and have enriched our medical armamentarium. Stented areas constitute vulnerable sites for endothelial damage, endothelial dysfunction, flow turbulence, hemorheologic changes, platelet dysfunction, coagulation changes and fibrinolytic disturbances. Implant surface attracts several proteins such as albumin, fibronectin, fibrinogen, and complement that lead to complement system activation. Macrophages recognize the implant as foreign substance due to protein adsorption and its continuous presence results in macrophage differentiation and fusion into foreign body giant cells. Polymer coating, stent metallic platforms and the released drugs can act as strong antigenic complex that apply continuous, repetitive, persistent and chronic hypersensitivity irritation to the coronary intima. The concomitant administration of oral antiplatelet drugs and environmental exposures can induce hypersensitivity inflammation. A class of platelets, activated via high-affinity and low-affinity IgE hypersensitivity receptors FCγRI, FCγRII, FCεRI and FCεRII, can induce Kounis hypersensitivity-associated thrombotic syndrome inside the stented coronaries. Type III variant of this syndrome is diagnosed when coronary artery stent thrombosis is associated with thrombus infiltrated by eosinophils or mast cells and/or when coronary intima, media and adventitia adjacent to stent, is infiltrated by eosinophils or mast cells. Careful history of hypersensitivity reactions to all implanted materials and concomitant drugs with monitoring of inflammatory mediators as well as lymphocyte transformation studies to detect hypersensitivity must be undertaken in order to avoid disastrous consequences. Food and Drug Administration recommendations for coronary stent implantation should be applied also to bioresorbable scaffolds. Further studies with inert and non-allergenic implants are necessary.

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Section: Causes Of Stent Thrombosismentioning

confidence: 99%

Thrombotic responses to coronary stents, bioresorbable scaffolds and the Kounis hypersensitivity-associated acute thrombotic syndrome

et al. 2017

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“…[ 50 ] Positive vascular remodelling, a consequence of late malapposition, has been linked with late stent thrombosis. [ 51 , 52 ] IVOCT facilitates better identification of neoatherosclerosis and uncovered stent struts, compared with other ICI modalities. [ 48 , 53 ]…”

Section: Specific Areas Where Ai Can Add Further Knowledgementioning

confidence: 99%

Artificial Intelligence for the Interventional Cardiologist: Powering and Enabling OCT Image Interpretation

Chandramohan,

Hinton,

O’Kane

et al. 2024

Interv Cardiol

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Intravascular optical coherence tomography (IVOCT) is a form of intra-coronary imaging that uses near-infrared light to generate high-resolution, cross-sectional, and 3D volumetric images of the vessel. Given its high spatial resolution, IVOCT is well-placed to characterise coronary plaques and aid with decision-making during percutaneous coronary intervention. IVOCT requires significant interpretation skills, which themselves require extensive education and training for effective utilisation, and this would appear to be the biggest barrier to its widespread adoption. Various artificial intelligence-based tools have been utilised in the most contemporary clinical IVOCT systems to facilitate better human interaction, interpretation and decision-making. The purpose of this article is to review the existing and future technological developments in IVOCT and demonstrate how they could aid the operator.

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“…39 Late malapposition can occur as a consequence of positive vascular remodeling, and has been attributed to very late stent thrombosis. 40,41 For assessment of late stent thrombosis, IVUS is preferable as it is able to evaluate the entire vessel wall. On the other hand, OCT is better at identifying neoatherosclerosis, and uncovered stent struts.…”

Section: Stent Selection and Stent Failurementioning

confidence: 99%

“…When compared to IVUS, OCT is twice as likely to pick up acute stent malapposition 39 . Late malapposition can occur as a consequence of positive vascular remodeling, and has been attributed to very late stent thrombosis 40,41 . For assessment of late stent thrombosis, IVUS is preferable as it is able to evaluate the entire vessel wall.…”

Section: Stent Selection and Stent Failurementioning

confidence: 99%

Intracoronary optical coherence tomography—An introduction

Mohan

Johnson

2022

Cathet Cardio Intervent

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Optical coherence tomography (OCT) utilizes near infrared light with a wavelength of 1.30 μm and is generated from a rotating fibre-optic system.When compared to intravascular ultrasound (IVUS), the shorter wavelength of OCT (1.3 μm) confers excellent axial resolution but at the cost of lower depth penetration (1-2 mm vs. 5-6 mm). Red blood cells have a strong tendency to absorb and scatter light, which attenuates the image. Therefore, when assessing coronary arteries with OCT, it is important to clear blood from the field of examination and this is usually done with a contrast agent. This makes it prone to artefacts from residual blood, and limits its use in patients with advanced chronic kidney disease, ectatic vasculature and aorto-ostial lesions where IVUS tends to be preferred. However, OCT outperforms IVUS in the assessment of calcific lesions, identification of high-risk plaque features, and studying the mechanism of stent failure. In this article, we provide an up-todate review of the technology behind OCT, its limitations, and how the two intracoronary imaging modalities compare in various clinical scenarios.

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Mechanisms of stent thrombosis: insights from optical coherence tomography

Cited by 6 publications

References 17 publications

Thrombotic responses to coronary stents, bioresorbable scaffolds and the Kounis hypersensitivity-associated acute thrombotic syndrome

Thrombotic responses to coronary stents, bioresorbable scaffolds and the Kounis hypersensitivity-associated acute thrombotic syndrome

Artificial Intelligence for the Interventional Cardiologist: Powering and Enabling OCT Image Interpretation

Intracoronary optical coherence tomography—An introduction

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