Multi-modality imaging for stent edge assessment

Optical coherence tomography (OCT) has a sufficiently high resolution to allow assessment of stent edge dissection (ED). The aims of the present study were as follows: (1) evaluation of the frequency of stent ED using OCT; (2) comparison of stent ED detection rates obtained using angiography, intravascular ultrasound (IVUS), and OCT; and (3) IVUS-Virtual Histology (IVUS-VH) evaluation of plaque composition at the site of stent EDs detected by OCT after percutaneous coronary intervention (PCI). Fifty-eight consecutive patients (59 lesions, 100 stent edges) who underwent balloon-expandable stent implantation and post-stent assessment with OCT and IVUS-VH were included. OCT revealed stent ED in 24.0 % (24 of 100) of stent edges after PCI with a balloon-expandable stent. In contrast, ED was detected in only 3.0 % (3 of 100) of stent edges using angiography and 4.0 % (4 of 100) of stent edges using IVUS. Plaque evaluation using IVUS-VH showed that the percent necrotic core (21.2 ± 8.3 vs. 13.4 ± 10.7 %, p = 0.001) and absolute dense calcium (2.9 ± 2.4 vs. 1.3 ± 2.2 mm(3), p = 0.0104) and dense calcium (13.8 ± 9.3 vs. 5.4 ± 5.8 %, p < 0.001) volumes were greater in the ED group than in the non-ED group. Thus, OCT is superior to conventional coronary angiography and IVUS in the identification of stent ED. In addition, the plaque composition at the ED site is characterized by a necrotic core and greater dense calcium levels than those observed at the non-ED site.