Optical coherence tomography for the diagnosis and management of stent thrombosis

Stent thrombosis (ST) is a rare but potentially fatal complication of percutaneous coronary interventions. With its high spatial resolution, optical coherence tomography (OCT) allows identification of underlying mechanical causes of stent thrombosis that may be overlooked by conventional angiography.

We conducted a prospective, single-center registry that consecutively included patients with a definitive diagnosis of ST who underwent OCT at the acute presentation. The presence of underlying mechanical abnormalities was assessed, and their likelihood as the primary cause of ST was determined. In-hospital and follow-up prognosis was evaluated.

A total of 105 patients were included in the final analysis. Mechanical abnormalities were identified by the OCT in 87% of cases and deemed the most probable cause of ST in 77.1%. Findings varied significantly by timing of stent thrombosis: in acute cases, no mechanical abnormality was most common (41.8%); in subacute cases, stent underexpansion predominated (47.8%); in late cases, malapposition was most frequent (30.8%); and in very late cases, neoatherosclerosis was the leading cause (52%). However, no significant differences were found in relation to the type of stent involved. In all cases, treatment was tailored to correct the detected abnormality, with a new stent being implanted in 52% of patients. There were no OCT-related complications.

OCT is a safe and valuable tool in the assessment of ST as it allows the identification of distinct causative mechanisms according to timing of ST and helps optimize the management of patients experiencing this rare but serious complication.