Incidence and potential mechanism of resolved, persistent and newly acquired malapposition three days after implantation of self-expanding or balloon-expandable stents in a STEMI population: insights from optical coherence tomography in the APPOSITION II study

Abstract

Three days after pPCI, tissue resorption and vasorelaxation were biological factors associated with new appearance of ISA while "early" recoil of balloon-expandable stents was a mechanical factor. Both persistent ISA and newly acquired ISA occurred less frequently in self-expanding stents, resulting in a low number of ISA segments compared to balloon-expandable stents. Clinical Trials Registration Information: Randomised Comparison Between the STENTYS Self-expanding Coronary Stent and a Balloon-expandable Stent in Acute Myocardial Infarction (APPOSITION II). ClinicalTrials.gov Identifier: NCT01008085

Post-dilatation improves stent apposition in patients with ST-segment elevation myocardial infarction receiving primary percutaneous intervention: A multicenter, randomized controlled trial using optical coherence tomography

“…Newly acquired ISA was caused by tissue reabsorption, vasorelaxation and early recoil in balloon-expandable stents, and maybe only tissue reabsorption in self-expanding stents. [19] Third, high pressure post-dilatation with noncompliant balloons effectively improves ISA, especially under the guidance of OCT. In the present study, post-dilatation significantly improved ISA in STEMI patients even under routine angiographic guidance.…”

Angioscopic Comparison of Early- and Mid-Term Vascular Responses Following Treatment of ST-Elevation Acute Myocardial Infarction With Biodegradable vs. Durable Polymer Everolimus-Eluting Stents ― A Prespecified Subanalysis of the MECHANISM AMI RCT ―

“…To enable assessment of local changes in vessel healing status, the matching of the segments at serial observations is mandatory with the finest level of matching possible. 20, 21 Patient-and lesion-level analyses cannot address the issue precisely. Therefore, the main analysis of the present study was performed at the segment level.…”

Early vascular healing after implantation of the polymer-free biolimus-eluting stent or the ultrathin strut biodegradable polymer sirolimus-eluting stent in patients with ST-segment elevation myocardial infarction

“…At baseline, there were no differences in malapposition prevalence, area or percentage of malapposed struts between the two groups, but there were significantly larger malapposition areas and more malapposed struts in the O-SES group, compared with the BF-BES group at follow-up. The mechanisms behind the acquired malapposition following stent implantation for STEMI could be stent recoil, positive remodeling, and vessel relaxation, and thrombus resorption [15,17,30]. The greater amount of evaginations and malapposed struts in the O-SES group could be explained by the stent construction.…”