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Suboptimal stent deployment is associated with subacute stent thrombosis: optical coherence tomography insights from
Francesco Prati1, Takahide Kodama2, Enrico Romagnoli3
1San Giovanni Hospital, Rome, Italy; CLI Foundation, Rome, Italy.
Insights
Optical coherence tomography (OCT) reveals nonoptimal stent deployment, including underexpansion and edge dissection, in nearly all subacute stent thrombosis (ST) cases. OCT may help prevent ST by guiding percutaneous coronary intervention.
Area of Science:
- Cardiovascular Imaging
- Interventional Cardiology
- Biomedical Engineering
Background:
- Subacute stent thrombosis (ST) is a serious complication of coronary stenting, potentially leading to acute coronary syndromes and sudden cardiac death.
- Understanding the mechanisms of ST is crucial for developing preventative strategies.
Purpose of the Study:
- To explore the role of optical coherence tomography (OCT) in elucidating the mechanisms of subacute stent thrombosis (ST).
- To identify specific OCT findings associated with nonoptimal stent deployment in patients experiencing ST.
Main Methods:
- OCT imaging was performed on 21 patients with subacute ST and compared to 42 control patients undergoing OCT for follow-up.
- Assessment focused on stent underexpansion, malapposition, edge dissection, and reference lumen narrowing.
Main Results:
- Patients with ST showed significantly smaller minimum stent areas and a higher incidence of stent underexpansion and edge dissection compared to controls.
- Nonoptimal stent deployment findings were present in 95.2% of ST patients versus 42.9% of controls.
- No significant differences were found in malapposition or reference lumen narrowing between groups.
Conclusions:
- OCT assessment of subacute ST patients reveals nonoptimal stent deployment in almost all cases, with underexpansion and edge dissection being key factors.
- OCT-guided percutaneous coronary intervention may offer a strategy for preventing stent thrombosis in complex cases.
Background:
Acute or subacute stent thrombosis (ST) is a well-described complication usually causing acute coronary syndromes and, in the worst case scenario, sudden cardiac death. In this study, we aimed at exploring the potential role of optical coherence tomography (OCT) in the understanding of the mechanism of ST.
Methods:
Twenty-one consecutive patients, after acute coronary syndromes due to a definite subacute ST, were assessed with OCT and matched 1:2 with 42 patients undergoing OCT for scheduled follow-up. Optical coherence tomography assessment was focused on features indicative of nonoptimal stent deployment: underexpansion, malapposition, edge dissection, and reference lumen narrowing.
Results:
Optical coherence tomography revealed a minimum stent area sensibly smaller in the ST group (5.6 ± 2.6 vs 6.8 ± 1.7 mm(2); P = .03) with a higher incidence of stent underexpansion when compared with the control group (42.8% vs 16.7%; P = .05). Dissection at stent edges was more commonly detected in ST group (52.4% vs 9.5%; P < .01). No significant differences between the 2 groups were observed for malapposition (52.4% vs 38.1%; P = .651) and reference lumen narrowing (19.0% vs 4.8%; P = .172). At least 1 OCT finding indicative of suboptimal stent deployment was detectable in 95.2% of patients experiencing ST versus 42.9% of the control group (P < .01).
Conclusions:
Optical coherence tomography assessment in patients experiencing subacute ST revealed nonoptimal stent deployment in almost all cases with higher incidence of stent underexpansion and edge dissection, potentially explaining the cause of this adverse event. The adoption of an OCT-guided percutaneous coronary intervention protocol could have a potential for the prevention of ST in complex cases.