Optical Coherence Tomography Findings in Patients with Coronary Stent Thrombosis: A Report of the PREvention of Late Stent Thrombosis by an Interdisciplinary Global European Effort (PRESTIGE) Consortium
Background—Stent thrombosis (ST) is a serious complication following coronary stenting. Intravascular optical coherence tomography (OCT) may provide insights into mechanistic processes leading to ST. We performed a prospective, multicenter study to evaluate OCT findings in patients with ST.
Methods—Consecutive patients presenting with ST were prospectively enrolled in a registry using a centralized telephone registration system. After angiographic confirmation of ST, OCT imaging of the culprit vessel was performed with frequency domain OCT. Clinical data were collected according to a standardized protocol. OCT acquisitions were analyzed at a core laboratory. Dominant and contributing findings were adjudicated by an imaging adjudication committee.
Results—231 patients presenting with ST underwent OCT imaging; 14 (6.1%) had image quality precluding further analysis. Of the remaining patients, 62 (28.6%) and 155 (71.4%) presented with early and late/very late ST respectively. The underlying stent type was new generation drug-eluting stent in 50.3%. Mean reference vessel diameter was 2.9±0.6 mm and mean reference vessel area was 6.8±2.6 mm2. Stent underexpansion (stent expansion index <0.8) was observed in 44.4% of patients. The predicted average probability (95% confidence interval) that any frame had uncovered (or thrombus-covered) struts was 99.3% (96.1%; 99.9%), 96.6% (92.4%; 98.5%), 34.3% (15.0%; 60.7%) and 9.6% (6.2%; 14.5%) and malapposed struts was 21.8% (8.4%; 45.6%), 8.5% (4.6%; 15.3%), 6.7% (2.5%; 16.3%) and 2.0% (1.2%; 3.3%) for acute, subacute, late and very late stent thrombosis respectively. The most common dominant finding adjudicated for acute ST was uncovered struts (66.7% of cases), for subacute ST was uncovered struts (61.7%) and underexpansion (25.5%), for late ST was uncovered struts (33.3%) and severe restenosis (19.1%), and for very late ST was neoatherosclerosis (31.3%) and uncovered struts (20.2%).. In patients presenting very late ST, uncovered stent struts was a common dominant finding in DES, and neoatherosclerosis in bare metal stents.
Conclusions—In patients with ST, uncovered and malapposed struts were frequently observed with the incidence of both decreasing with longer time intervals between stent implantation and presentation. The most frequent dominant observation varied according to time intervals from index stenting: uncovered struts and underexpansion in acute/subacute ST and neoatherosclerosis and uncovered struts in late/very late ST.
- Received January 12, 2017.
- Revision received May 30, 2017.
- Accepted June 15, 2017.
Circulation is published on behalf of the American Heart Association, Inc., by Wolters Kluwer. This is an open access article under the terms of the Creative Commons Attribution Non-Commercial-NoDervis License (http://creativecommons.org/licenses/by-nc-nd/3.0/), which permits use, distribution, and reproduction in any medium, provided that the original work is properly cited, the use is noncommercial, and no modifications or adaptations are made.