Optical coherence tomography: evaluating the effects of stent boost subtract imaging on stent underexpansion in STEMI patients

Abstract

Background To evaluate the effect of stent boost subtract (SBS) imaging on stent underexpansion during percutaneous coronary intervention (PCI) in patients with acute ST-segment elevation myocardial infarction (STEMI) by optical coherence tomography (OCT). Methods One hundred thirty-eight STEMI patients who underwent drug-eluting stent (DES) implantation were prospectively recruited and divided into the SBS group (69 cases) and the CAG group (69 cases) according to whether SBS was used to guide PCI. Finally, OCT was performed on all enrolled patients, and the OCT results were used as the gold standard to evaluate the impact of standard SBS technology on stent underexpansion immediately after DES implantation. Results SBS identified 51 patients (24%) with stent underexpansion while OCT identified 56 patients (27.2%). SBS has a sensitivity of 80%, a specificity of 96%, a positive predictive value of 88%, and a negative predictive value of 93% for identifying stent underexpansion. Conclusion Compared with OCT, SBS technology is a rapid stent imaging evaluation method that can accurately quantify the stent expansion level and is time-saving and economical.

Value of stent boost imaging in decision making after coronary stenting

“…This difference mostly attributed to the larger percentage of cases needed pre-dilation that was not ideally performed (using small sized PTCA semi-compliant balloons, no use of 1:1 balloon to vessel size, no use of NC balloons; noting that 40% of our study cases needed pre-dilatation). Similarly, the current results were consistent with Yuanyuan Duan et al [ 18 ] as they found suboptimal results in 24% of STEMI cases (all study cases were acute MI, indicating more soft lesions that were stented). Also, Kang et al [ 28 ] found that 42% of cases during their study had stent under expansion by IVUS.…”

“…The specificity of SB image for adequate stent deployment is high (100% when assessed by IVUS, and 96% when assessed by optical coherence tomography (OCT)), so it could be used as the first line for monitoring just after stent implantation in centres where IVUS is not routinely used. [ 17 , 18 ]. In our practice we do not use IVUS frequently for assessing the results of stent deployment, which is a major requirement that should be fulfilled.…”