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Updated: Feb 24, 2026
Imaging In-Stent Restenosis: An Inexpensive, Reliable, and Rapid Preclinical Model
Published on: September 14, 2009
Classification of mechanisms of strut malapposition after angiographically optimized stent implantation: An optical
Mayank Agrawal1, Abdul Hakeem1, Zubair Ahmed1
1Division of Cardiovascular Medicine, Department of Internal Medicine, Central Arkansas Veterans Healthcare System, University of Arkansas for Medical Sciences, Little Rock, Arkansas.
Aims:
To elucidate causes and extent of strut malapposition in angiographically optimized stenting.
Methods And Results:
Using a new classification system for strut malapposition, the mechanisms of stent strut malapposition were classified as localized lumen enlargement, vessel asymmetry, stent undersizing, strut underexpansion and stent deployment issue. Stent implantations (n = 110) in 100 consecutive patients undergoing optical coherence tomography (OCT) after the operator considered the stent as optimally deployed angiographically were reviewed to determine if strut apposition was complete. 127,894 stent struts in 110 stents were analyzed. There were 6,644 struts malapposed (5.2% ±7.3%), with strut malapposition found in 82 of 110 stents (74.5%). Localized lumen enlargement was the most common cause of malapposition (74.4% of malapposition clusters). Stent undersizing was the second most common cause (46.3%) followed by strut under-expansion in 29.3%, stent deployment issue in 18.2%, and vessel asymmetry in 9.7%.
Conclusion:
Malapposition of any degree is common after angiographic stent optimization, occurring in up to three-quarters of stents. The most frequent mechanism was localized lumen enlargement. The second most common cause of strut malapposition was stent undersizing, which was angiographically invisible. Whether performing OCT after angiographic optimization improves short- and long-term outcomes requires further study. © 2017 Wiley Periodicals, Inc.
