Novel volumetric analysis for stent expansion after drug‐eluting stent implantation: An optical coherence tomography study

Abstract

Objectives To assess the clinical significance of a novel optical coherence tomography (OCT)‐derived volumetric parameter of stent expansion by comparing it with the conventional parameters in real‐world practice. Background The clinical significance of novel parameters in real‐world practice including longer and smaller stents remains to be elucidated. Methods A total of 226 de novo lesion treated with drug‐eluting stents in 208 consecutive patients were enrolled. Stent expansion was retrospectively assessed on the final OCT images after stent implantation. The novel parameter was the minimum expansion index (MEI) calculated using a novel algorithm that yields the ideal lumen area in each frame by taking into account vessel tapering. The device‐oriented clinical end point (DoCE) included cardiac death, target vessel‐related myocardial infarction, ischemia‐driven target lesion revascularization. Results The MEI in the lesions with a DoCE (n = 22) at 2 years and cases without a DoCE (n = 204) was 64.3 ± 12.0% and 78.5 ± 14.6%, respectively (p < .001). In the receiver operating characteristic curve analyses, the areas under the curve for the MEI (0.787; p < .001) were larger than that for %stent expansion (0.718; p = .001) and minimum stent area (0.664; p = .004) in predicting the DoCE. The best cutoff of MEI for predicting the DoCE was 74.0. Conclusions The novel MEI was better than the conventional %stent expansion and minimum stent area for predicting DoCE.

Volumetric Stent Expansion Index to Assess Tapering Lesions Using Intravascular Ultrasound and Its Clinical Outcomes

“…In contrast, a different cut-off value was reported for OCT-derived volumetric parameters (74.0% in Katsura et al . [ 12 ] and 62.2% in the present cohort). One explanation may be that the rate of post-dilatation in the relevant segment of the stent was higher in our study than in Katsura et al .…”

“…One explanation may be that the rate of post-dilatation in the relevant segment of the stent was higher in our study than in Katsura et al . [ 12 ] (100% vs . 80.5% ).…”

“…However, the area of under-expansion cannot be accurately assessed. Hence, the volumetric analysis of lumen expansion that considers each CTL is likely to show greater functional precision, and thus, more accurately predict the outcomes [ 12 , 13 ]. The present study aimed to identify the best stent expansion index (SEI) to evaluate the impact of 2-year percutaneous coronary intervention (PCI) clinical outcomes in coronary tapering lesions.…”

OCT Guidance in Bifurcation Percutaneous Coronary Intervention

“…[ 33 ]) or as a minimal stent area of the proximal and/or distal segment 90% of the proximal and/or distal reference lumen area respectively (according to ILUMIEN III trial). Recently, a refined OCT-based parameter of stent expansion, the minimum expansion index, that yields the ideal lumen area in each frame by taking into account vessel tapering, has been shown to correlate with device-oriented clinical endpoints [ 34 ]. Stent expansion should be evaluated separately in the proximal MV, distal MV and SB, with respect to each reference area.…”