Natural consequence of post-intervention stent malapposition, thrombus, tissue prolapse, and dissection assessed by optical coherence tomography at mid-term follow-up

Hiroyuki Kawamori, Junya Shite, Toshiro Shinke, Hiromasa Otake, Daisuke Matsumoto, Masayuki Nakagawa, Ryoji Nagoshi, Amane Kozuki, Hirotoshi Hariki, Takumi Inoue, Tsuyoshi Osue, Yu Taniguchi, Ryo Nishio, Noritoshi Hiranuma, Ken-ichi Hirata, Hiroyuki Kawamori, Junya Shite, Toshiro Shinke, Hiromasa Otake, Daisuke Matsumoto, Masayuki Nakagawa, Ryoji Nagoshi, Amane Kozuki, Hirotoshi Hariki, Takumi Inoue, Tsuyoshi Osue, Yu Taniguchi, Ryo Nishio, Noritoshi Hiranuma, Ken-ichi Hirata

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.

Keywords: Optical coherence tomography; Stent edge dissection; Stent malapposition; Thrombus; Tissue prolapse.

Figures

Figure 1
Figure 1
Representative OCT images: (A) classification of malapposed struts: (a) resolved malapposition, (b) persistent malapposition, (c) late-acquired malapposition, (B) classification of thrombus: (a) resolved thrombus, (b) persistent thrombus, (c) late-acquired thrombus, (C) tissue prolapse, (D) edge dissection.
Figure 2
Figure 2
Number of abnormal findings after stenting: (A) stent malapposition, (B) thrombus, (C) tissue prolapse, (D) edge dissection.
Figure 3
Figure 3
The frequency of neointimal coverage and the measurement of neointimal thickness between resolved malapposed struts, persistent malapposed struts, and late-acquired malapposed struts: (A) the incidence of struts without neointima was significantly higher in late-acquired and persistent malapposed struts compared with resolved malapposed struts. (B) The mean neointimal thickness of resolved malapposed struts was significantly thicker than that of the persistent and late-acquired malapposed struts.
Figure 4
Figure 4
ROC curve analysis and distribution of S–V distance of post-procedural malapposed struts. (A) An S–V distance ≤260 µm was the corresponding cut-off point for a resolved malapposed strut with a maximum sensitivity of 89.3% and a specificity of 83.7% (AUC = 0.884, P = 0.001). (B) Only eight struts with an S–V distance ≤260 μm persisted.
Figure 5
Figure 5
A case of persistent malapposed struts with a baseline S–V distance ≤260 μm: left panel shows the OCT image immediately after Taxus Liberte™ implantation. The S–V distance is 180 μm, which is less than the cut-off value of the S–V distance of 260 μm. These malapposed struts persisted on follow-up OCT images (right panel), probably due to plaque regression or thrombus dissolution.
Figure 6
Figure 6
Comparison of ROC curve analysis and distribution of S–V distance between SES and PES: (A) SES; an S–V distance of ≤280 was the best cut-off point for a resolved malapposed strut with a maximum sensitivity of 95.0% and a specificity of 100% (AUC: 0.991). All the malapposed struts with an S–V distance ≤280 μm changed to be well-apposed. (B) PES; an S–V distance of ≤260 was the best cut-off point for a resolved malapposed strut (sensitivity 87.8%, specificity 80.0%, AUC = 0.865). Eight malapposed struts with S–V distance ≤260 μm persisted.
Figure 7
Figure 7
A representative case of thrombus with late stent malapposition.

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