The fate of incomplete stent apposition with drug-eluting stents: an optical coherence tomography-based natural history study

• Published in: European heart journal 2010-06, Vol.31 (12), p.1470-1476
• Main Authors: Ozaki, Yukio, Okumura, Masanori, Ismail, Tevfik F., Naruse, Hiroyuki, Hattori, Kousuke, Kan, Shino, Ishikawa, Makoto, Kawai, Tomoko, Takagi, Yasushi, Ishii, Junichi, Prati, Francesco, Serruys, Patrick W.
• Format: Article
• Language: English
• Subjects: Aged; Biological and medical sciences; Blood Vessel Prosthesis; Blood Vessel Prosthesis Implantation - methods; Cardiology. Vascular system; Coronary Restenosis - diagnostic imaging; Coronary Restenosis - prevention & control; Coronary Thrombosis - diagnostic imaging; Coronary Thrombosis - prevention & control; Drug-eluting stent; Drug-Eluting Stents; Female; Graft Occlusion, Vascular - diagnostic imaging; Graft Occlusion, Vascular - etiology; Humans; Immunosuppressive Agents - administration & dosage; Incomplete stent apposition; IVUS; Male; Medical sciences; Middle Aged; OCT; Prosthesis Failure; Radiography; Radiotherapy. Instrumental treatment. Physiotherapy. Reeducation. Rehabilitation, orthophony, crenotherapy. Diet therapy and various other treatments (general aspects); Restenosis; Sirolimus - administration & dosage; Stent thrombosis; Tomography, Optical Coherence; Ultrasonography, Interventional
• ISSN: 0195-668X; 1522-9645
• DOI: 10.1093/eurheartj/ehq066

Aims To assess the fate of incomplete stent apposition (ISA) after deployment of sirolimus-eluting stents (SESs). Methods and results Thirty-two patients having intravascular ultrasound (IVUS)-guided PCI with SESs underwent assessment of stent deployment with quantitative coronary angiography, IVUS, and optical coherence tomography (OCT) pre-procedure, post-procedure, and at 10 months follow-up. Incomplete stent apposition was defined as separation of a stent strut from the inner vessel wall by >160 µm. At follow-up, 4.67% of struts with ISA at deployment failed to heal and 7.59% which were well apposed did not develop neointimal hyperplasia even after 10 months. Lesion remodelling was responsible for the development of late ISA in only 0.37% of struts. Failure of adequate neointimal hyperplasia was quantitatively the most important mechanism responsible for persistent acute ISA, classified in previous studies, which relied only on follow-up OCT, as late ISA. Thrombus was visualized in 20.6% of struts with ISA at follow-up and in 2.0% of struts with a good apposition (P < 0.001). Conclusion In patients with SESs, ISA can fail to heal and even complete apposition can be associated with no neointimal hyperplasia. Incomplete stent apposition without neointimal hyperplasia was significantly associated with the presence of OCT-detected thrombus at follow-up, and may constitute a potent substrate for late stent thrombosis.