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- Title
Natural consequence of post-intervention stent malapposition, thrombus, tissue prolapse, and dissection assessed by optical coherence tomography at mid-term follow-up.
- Authors
Kawamori, Hiroyuki; Shite, Junya; Shinke, Toshiro; Otake, Hiromasa; Matsumoto, Daisuke; Nakagawa, Masayuki; Nagoshi, Ryoji; Kozuki, Amane; Hariki, Hirotoshi; Inoue, Takumi; Osue, Tsuyoshi; Taniguchi, Yu; Nishio, Ryo; Hiranuma, Noritoshi; Hirata, Ken-ichi
- Abstract
Aims We performed this study to clarify natural consequences of abnormal structures (stent malapposition, thrombus, tissue prolapse, and stent edge dissection) after percutaneous coronary intervention (PCI). Methods and results Thirty-five patients treated with 40 drug-eluting stents underwent serial optical coherence tomography (OCT) imaging immediately after PCI and at the 8-month follow-up. Among a total of 73 929 struts in every frame, 431 struts (26 stents) showed malapposition immediately after PCI. Among these, 49 remained malapposed at the follow-up examination. The mean distance between the strut and vessel wall (S–V distance) of persistent malapposed struts on post-stenting OCT images was significantly longer than that of resolved malapposed struts (342 ± 99 vs. 210 ± 49 μm; P <0.01). Based on receiver-operating characteristic curve analysis, an S–V distance ≤260 µm on post-stenting OCT images was the corresponding cut-off point for resolved malapposed struts (sensitivity: 89.3%, specificity: 83.7%, area under the curve = 0.884). Additionally, 108 newly appearing malapposed struts were observed on follow-up OCT, probably due to thrombus dissolution or plaque regression. Thrombus was observed in 15 stents post-PCI. Serial OCT analysis revealed persistent thrombus in 1 stent, resolved thrombus in 14 stents, and late-acquired thrombus in 8 stents. Tissue prolapse observed in 38 stents had disappeared at the follow-up. All eight stent edge dissections were repaired at the follow-up. Conclusion Most cases of stent malapposition with a short S–V distance, thrombus, tissue prolapse, or minor stent edge dissection improved during the follow-up. These OCT-detected minor abnormalities may not require additional treatment.
- Subjects
MYOCARDIAL revascularization; SURGICAL stents; TOMOGRAPHY; TRANSLUMINAL angioplasty; RECEIVER operating characteristic curves
- Publication
European Heart Journal - Cardiovascular Imaging, 2013, Vol 14, Issue 9, p865
- ISSN
2047-2404
- Publication type
Article
- DOI
10.1093/ehjci/jes299