Coronary evaginations are associated with positive vessel remodelling and are nearly absent following implantation of newer-generation drug-eluting stents: an optical coherence tomography and intravascular ultrasound study

Radu, Maria; Räber, Lorenz; Kalesan, Bindu; Muramatsu, Takashi; Kelbæk, Henning; Heo, Jung-Ho; Jørgensen, Erik; Helqvist, Steffen; Farooq, Vasim; Brugaletta, Salvatore; García‐García, Héctor M.; Jüni, Peter; Saunamäki, Kari; Windecker, Stephan; Serruys, Patrick W.

doi:10.1093/eurheartj/eht344

Cited by 69 publications

(46 citation statements)

References 36 publications

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“…CAG showed no (re)stenosis or stent thrombosis but slight peri-stent contrast staining was identified in the proximal LAD (Figure 1B). Frequency domain OCT (C7 system, St. Jude Medical, Memphis, USA) showed peri-stent evaginations, as described by Raber et al and detailed by Radu et al (6,7), and uncovered stent struts and multiple luminal thrombi (Figure 1C). The stent was well expanded compared to reference segments.…”

Section: Methodssupporting

confidence: 54%

“…Some recent reports also include new in-stent atherosclerotic plaques (neoatherosclerosis) as substrate for ACS late after DES implantation (17). The potential problems with positive remodeling after stenting with first-generation DES are supported in a recent paper by Radu et al, where they state that OCT-detected coronary evaginations are associated with late stent thrombosis (7). …”

Section: Discussionmentioning

confidence: 93%

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Clinical use of optical coherence tomography to identify angiographic silent stent thrombosis

Steigen

Holm

Butt

et al. 2014

Scandinavian Cardiovascular Journal

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ObjectivesPatients previously treated with coronary stents may suffer an acute coronary syndrome (ACS) without any evidence of thrombus formation on coronary angiography (CAG). This may be due to partial, nonocclusive stent thrombosis with microembolization. In this paper, we illustrate possible mechanisms both with optical coherence tomography (OCT) and histology.DesignWe present two cases with ACS from very late stent thrombosis who have been previously treated with first-generation drug-eluting stents (DES).ResultsThe first patient had ACS 15 months after DES implantation. The angiogram (CAG) was near normal with slight peri-stent contrast staining. OCT revealed abnormalities including thrombus not visible on CAG. These are findings that may explain the ACS. The second patient had subclinical episodes with chest pain after DES implantation. The patient died from stent thrombosis in a DES. Postmortem histological examination of the coronary arteries revealed stent struts with little or no neointimal coverage, persistent peri-strut fibrin deposition, inflammatory cells, malapposition, and small luminal platelet-rich thrombi. Old spotty myocardial infarctions were found in the supplied territory possibly caused by earlier episodes of embolizing thrombus.ConclusionsIn patients with previous implanted DES presenting with ACS, OCT may detect abnormalities and thrombus formation not visible on CAG. Such findings may impact the treatment strategy in these patients.

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Section: Methodssupporting

confidence: 54%

Section: Discussionmentioning

confidence: 93%

Clinical use of optical coherence tomography to identify angiographic silent stent thrombosis

Steigen

Holm

Butt

et al. 2014

Scandinavian Cardiovascular Journal

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“…OCT analyses were performed as previously described. [13][14][15] Stented segments were analyzed at 0.4-mm intervals by an independent analyst (M.T.) blinded to time point after DES implantation.…”

Section: Oct Acquisition and Analysesmentioning

confidence: 99%

Mechanisms of Very Late Drug-Eluting Stent Thrombosis Assessed by Optical Coherence Tomography

et al. 2016

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T he advent of coronary stents in conjunction with potent adjunctive medical treatment has resulted in substantial improvements in the efficacy and safety of percutaneous coronary interventions (PCIs).1 Although infrequent, stent thrombosis remains an important concern because of its sequelae, including myocardial infarction and death in up to 80%. 2,3 Early stent thrombosis is largely independent of stent type and mainly related to procedural variables, including major edge dissections and stent underexpansion. 4 Conversely, the mechanisms underlying very late stent thrombosis (VLST), occurring beyond 1 year after drug-eluting stent (DES) implantation, remain poorly defined, and the translation of mechanistic insights into therapeutic approaches is unsatisfactory. Despite an attenuation of the risk for VLST with the use of newer-generation DES, which is similar to that of bare metal stents, the accumulated long-term risk is still notable. Clinical Perspective on p 660Because of its high resolution (10-20 μm), optical coherence tomography (OCT) has become the imaging modality of choice for the in vivo assessment of stent failures, including VLST. 5 As a result of the infrequent encounter of this Background-The pathomechanisms underlying very late stent thrombosis (VLST) after implantation of drug-eluting stents (DES) are incompletely understood. Using optical coherence tomography, we investigated potential causes of this adverse event. Methods and Results-Between August 2010 and December 2014, 64 patients were investigated at the time point of VLST as part of an international optical coherence tomography registry. Optical coherence tomography pullbacks were performed after restoration of flow and analyzed at 0.4 mm. A total of 38 early-and 20 newer-generation drug-eluting stents were suitable for analysis. VLST occurred at a median of 4.7 years (interquartile range, 3.1-7.5 years). An underlying putative cause by optical coherence tomography was identified in 98% of cases. The most frequent findings were strut malapposition (34.5%), neoatherosclerosis (27.6%), uncovered struts (12.1%), and stent underexpansion (6.9%). Uncovered and malapposed struts were more frequent in thrombosed compared with nonthrombosed regions (ratio of percentages, 8.26; 95% confidence interval, 6.82-10.04; P<0.001 and 13.03; 95% confidence interval, 10. 13-16.93; P<0.001, respectively). The maximal length of malapposed or uncovered struts (3.40 mm; 95% confidence interval, 2.55-4.25; versus 1.29 mm; 95% confidence interval, 0.81-1.77; P<0.001), but not the maximal or average axial malapposition distance, was greater in thrombosed compared with nonthrombosed segments. The associations of both uncovered and malapposed struts with thrombus were consistent among early-and newer-generation drug-eluting stents. Conclusions-The leading associated findings in VLST patients in descending order were malapposition, neoatherosclerosis, uncovered struts, and stent underexpansion without differences between patients treated with early-and new...

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“…A bioresorbable vascular scaffold (BVS) thrombosis was used in presence of an outward bulge in the luminal vessel contour between apposed struts with a maximum depth of the bulge exceeding that of the actual strut thickness. 21 Edge dissection was defined as a disruption or discontinuity of the endoluminal vessel surface connecting to the proximal or distal stent edge. 22 Edge-related disease progression was defined as the presence of a ruptured necrotic core plaque at the proximal edge of the stent in an incompletely covered lesion.…”

Section: Baseline Characteristicsmentioning

confidence: 99%

Antiplatelet Drug Regimen in Patients With Stent Thrombosis　― Insights From the PESTO French Optical Coherence Tomography Registry ―

Amabile

Cayla

Motreff

et al. 2017

Circ J

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Thrombosis) French multicenter prospective observational registry reported that a stent mechanical abnormality was present in 97% of subjects with ST explored by intracoronary optical coherence tomography (OCT) imaging. 5 Premature discontinuation and incomplete individual response to APT have previously been reported as major risk factors for ST. 6,7 However, the interactions between APT regimen and potential underlying stent abnormalities remain largely unknown, even though different mechanical substrates could favor a rheological environment that might promote thrombosis. For example, uncovered/poorly healed struts behave as foreign bodies that induce platelet A lthough its frequency has decreased over the recent past years, stent thrombosis (ST) remains a major complication of percutaneous coronary interventions (PCI) and still carries a high mortality. 1 ST is a multifaceted process that can be triggered by different factors such as the patient's clinical characteristics, efficacy of antiplatelet therapy (APT) or underlying mechanical stent abnormalities. 2 However, coronary angiography has limited sensitivity to correctly identify these latter mechanisms and recent studies suggest that intracoronary imaging is a valuable option to achieve this purpose.

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Coronary evaginations are associated with positive vessel remodelling and are nearly absent following implantation of newer-generation drug-eluting stents: an optical coherence tomography and intravascular ultrasound study

Cited by 69 publications

References 36 publications

Clinical use of optical coherence tomography to identify angiographic silent stent thrombosis

Clinical use of optical coherence tomography to identify angiographic silent stent thrombosis

Mechanisms of Very Late Drug-Eluting Stent Thrombosis Assessed by Optical Coherence Tomography

Antiplatelet Drug Regimen in Patients With Stent Thrombosis　― Insights From the PESTO French Optical Coherence Tomography Registry ―

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Coronary evaginations are associated with positive vessel remodelling and are nearly absent following implantation of newer-generation drug-eluting stents: an optical coherence tomography and intravascular ultrasound study

Cited by 69 publications

References 36 publications

Clinical use of optical coherence tomography to identify angiographic silent stent thrombosis

Clinical use of optical coherence tomography to identify angiographic silent stent thrombosis

Mechanisms of Very Late Drug-Eluting Stent Thrombosis Assessed by Optical Coherence Tomography

Antiplatelet Drug Regimen in Patients With Stent Thrombosis ― Insights From the PESTO French Optical Coherence Tomography Registry ―

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Antiplatelet Drug Regimen in Patients With Stent Thrombosis　― Insights From the PESTO French Optical Coherence Tomography Registry ―