Clinical Implications of Poststent Optical Coherence Tomographic Findings

Kim, Byung Gyu; Kachel, Mateusz; Kim, Jung Sun; Guagliumi, Giulio; Kim, Choongki; Kim, In Soo; Lee, Yong Joon; Lee, Oh Hyun; Byun, Young Sup; Kim, Byung Ok; Milewski, Krzysztof; Lee, Seung Jun; Hong, Sung Jin; Ahn, Chul‐Min; Shin, Dong Ho; Ko, Young Guk; Choi, Donghoon; Jang, Yangsoo

doi:10.1016/j.jcmg.2021.03.008

Cited by 19 publications

(13 citation statements)

References 22 publications

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“…The relevance and clinical impact of malapposition has long been topic of debate, with intracoronary imaging studies yielding varying results. Yet, a recent study by Kim et al 7 demonstrated a significant impact of malapposition volume on major safety events. Acknowledging the latter, the higher rate of malapposition in more severely calcified lesions may be an important additional mediator in the association between calcification and clinical outcomes that warrants further investigation.…”

Section: Discussionmentioning

confidence: 99%

“…Hence, a more comprehensive metric may be needed to identify lesions that may benefit from the use of more aggressive lesion preparation. Fujino et al 14 et al 7 demonstrated a significant impact of malapposition volume on major safety events. Acknowledging the latter, the higher rate of malapposition in more severely calcified lesions may be an important additional mediator in the association between calcification and clinical outcomes that warrants further investigation.…”

Section: Discussionmentioning

confidence: 99%

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Optical coherence tomography‐derived predictors of stent expansion in calcified lesions

Plantes

Scoccia

Neleman

et al. 2023

Cathet Cardio Intervent

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Background Severe coronary artery calcification is associated with stent underexpansion and subsequent stent failure. Aims We aimed to identify optical coherence tomography (OCT)‐derived predictors of absolute (minimal stent area [MSA]) and relative stent expansion in calcified lesions. Methods This retrospective cohort study included patients who underwent percutaneous coronary intervention (PCI) with OCT assessment before and after stent implantation between May 2008 and April 2022. Pre‐PCI OCT was used to assess calcium burden and post‐PCI OCT was used to assess absolute and relative stent expansion. Results A total of 361 lesions in 336 patients were analyzed. Target lesion calcification (defined as OCT‐detected maximum calcium angle ≥ 30°) was present in 242 (67.0%) lesions. Following PCI, median MSA was 5.37 mm2 in calcified lesions and 6.24 mm2 in noncalcified lesions (p < 0.001). Median stent expansion was 78% in calcified lesions and 83% in noncalcified lesions (p = 0.325). In the subset of calcified lesions, average stent diameter, preprocedural minimal lumen area, and total calcium length were independent predictors of MSA in multivariable analysis (mean difference 2.69 mm2/mm2, 0.52 mm2/mm, and −0.28 mm2/5 mm, respectively, all p < 0.001). Total stent length was the only independent predictor of relative stent expansion (mean difference −0.465% per mm, p < 0.001). Calcium angle, thickness, and the presence of nodular calcification were not significantly associated with MSA or stent expansion in multivariable analyses. Conclusion Calcium length appeared to be the most important OCT‐derived predictor of MSA, whereas stent expansion was mainly determined by total stent length.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Optical coherence tomography‐derived predictors of stent expansion in calcified lesions

Plantes

Scoccia

Neleman

et al. 2023

Cathet Cardio Intervent

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“…In the ILLUMIEN III study, stent distance to the wall ≥200 μm was an independent predictor of major adverse cardiovascular events, while distance was acceptable in the range of <200 μm ( 16 ). The European Association of Percutaneous Coronary Intervention recommends that a distance of ≥400 μm and a length of ≥1 mm or more are defined as significant stent malapposition on the OCT image after percutaneous coronary intervention (PCI) ( 17 ). As can be seen, even in the field of cardiovascular interventions, the definition of thresholds remains somewhat controversial.…”

Section: Discussionmentioning

confidence: 99%

Evaluation of the apposition in unruptured aneurysms treated with flow diverters by optical coherence tomography: Preliminary clinical experience

Gong²,

Li³

et al. 2022

Front. Neurol.

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BackgroundThe risk of perioperative stroke and the rate of occlusion of long-term aneurysms in the treatment of unruptured aneurysms with flow diverters (FDs) are affected by stent apposition. Optical coherence tomography (OCT) may be an optional technique in evaluating apposition.PurposeTo explore the feasibility of the OCT imaging technique in evaluating stent apposition in the clinical application of the FD for unruptured aneurysms.MethodsOCT and Vaso CT were used in patients with indications for surgery to treat unruptured aneurysms with the FDs, to evaluate the apposition of the FDs after fully released, and to analyze OCT images for FDs apposition and compare with corresponding Vaso CT images.ResultsA total of four patients were enrolled, and OCT found malapposition after FDs placement in all four patients, and the maximum gap between the stent and vascular wall ranged from 0.68 to 1.95 mm and the length of malapposition ranged from 1.80 to 7.40 mm. However, Vaso CT found malapposition only in two of the four patients and missed malapposition near aneurysm in all three patients treated by the FD combined with coiling and could not accurately evaluate the maximum gap and the length of the malapposition.ConclusionThe optical coherence tomography technique is a possible approach to evaluate apposition after the treatment of unruptured aneurysms by the FDs.

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“…14 We found a numerically higher percentage of malapposed struts in the LUS group, immediately after stent implantation and at 3-month follow-up, with greater but clinically irrelevant malapposition areas and volumes. 15 However, the optimal stent deployment with an expansion index of 84% in both groups, achieved with…”

Section: Us and Malappositionmentioning

confidence: 94%

Determinants and long‐term outcomes of largely uncovered struts in thin‐struts drug‐eluting stents assessed by optical coherence tomography

Moretti

Bernelli

Pellegrini

et al. 2022

Cathet Cardio Intervent

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Background Uncovered struts are a determinant of stent failure. The impact of plaque composition and procedural factors on the occurrence, evolution, and outcomes of uncovered struts in a high‐risk setting has not been investigated. Objective To investigate the determinants and long‐term clinical impact of largely uncovered struts (LUS) in thin‐struts drug‐eluting stents (DES) implanted in complex lesions by intracoronary optical coherence tomography (OCT). Methods Ninety patients with multivessel disease undergoing staged complete revascularization were randomly assigned to bioabsorbable or durable polymer DES. OCT were serially performed during the index procedure, at 3‐ and 18‐month follow‐up, and analyzed by an independent core lab. Struts were defined uncovered by OCT if no tissue was visible above the struts. LUS were defined as ≥30% of uncovered struts at 3‐month follow‐up. Clinical outcomes were the occurrence of target vessel failure (TVF) and major adverse cardiac and cerebrovascular events (MACCE) at 5‐year follow‐up. Results LUS occurred in 31 patients (34.4%) regardless of stent platform. At 5 years, no differences were observed in the rate of TVF (12.7% vs. 13.4%; p = 0.91) and MACCE (23.9% vs. 24.9%; p = 0.88) between the two groups. At multivariate logistic regression, plaque rupture, mean lumen diameter, proximal reference vessel area, and maximum stent deployment pressure were independent predictors of LUS. Conclusions LUS are a frequent finding in complex coronary lesions treated with thin‐struts DES, especially in the presence of plaque rupture. However, in this study, no significant safety signal related to LUS emerged in long‐term follow‐up.

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Clinical Implications of Poststent Optical Coherence Tomographic Findings

Cited by 19 publications

References 22 publications

Optical coherence tomography‐derived predictors of stent expansion in calcified lesions

Optical coherence tomography‐derived predictors of stent expansion in calcified lesions

Evaluation of the apposition in unruptured aneurysms treated with flow diverters by optical coherence tomography: Preliminary clinical experience

Determinants and long‐term outcomes of largely uncovered struts in thin‐struts drug‐eluting stents assessed by optical coherence tomography

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