Francesco Prati1, Takahide Kodama2, Enrico Romagnoli3, Laura Gatto4, Luca Di Vito5, Vito Ramazzotti5, Alberto Chisari3, Valeria Marco3, Alberto Cremonesi6, Guido Parodi7, Mario Albertucci4, Fernando Alfonso8. 1. San Giovanni Hospital, Rome, Italy; CLI Foundation, Rome, Italy. Electronic address: fprati@hsangiovanni.roma.it. 2. IRCCS Foundation, Policlinico San Matteo, Pavia, Italy. 3. CLI Foundation, Rome, Italy. 4. San Giovanni Hospital, Rome, Italy; CLI Foundation, Rome, Italy. 5. San Giovanni Hospital, Rome, Italy. 6. GVM Care and Research, E S Health Science Foundation, Cotignola, Italy. 7. Careggi Hospital, Florence, Italy. 8. Hospital Universitario de la Princesa, IIS-IP, Madrid, Spain.
Abstract
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.
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.
Authors: Florian Blachutzik; Niklas Boeder; Jens Wiebe; Alessio Mattesini; Oliver Dörr; Astrid Most; Timm Bauer; Jens Röther; Monique Tröbs; Christian Schlundt; Stephan Achenbach; Christian W Hamm; Holger M Nef Journal: Clin Res Cardiol Date: 2016-10-18 Impact factor: 5.460
Authors: Tom Adriaenssens; Michael Joner; Thea C Godschalk; Nikesh Malik; Fernando Alfonso; Erion Xhepa; Dries De Cock; Kenichi Komukai; Tomohisa Tada; Javier Cuesta; Vasile Sirbu; Laurent J Feldman; Franz-Josef Neumann; Alison H Goodall; Ton Heestermans; Ian Buysschaert; Ota Hlinomaz; Ann Belmans; Walter Desmet; Jurrien M Ten Berg; Anthony H Gershlick; Steffen Massberg; Adnan Kastrati; Giulio Guagliumi; Robert A Byrne Journal: Circulation Date: 2017-07-18 Impact factor: 29.690