The fate of incomplete stent apposition with drug-eluting stents: an optical coherence tomography-based natural history study.
OBJECTIVE
To assess the fate of incomplete stent apposition (ISA) after deployment of sirolimus-eluting stents (SESs).


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 microm. 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).


CONCLUSIONS
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.
Ozaki
Yukio
Y
Department of Cardiology, Fujita Heath University Hospital, 1-98 Dengaku, Kutsukake, Toyoake 470-1192, Japan. ozakiyuk@fujita-hu.ac.jp
Okumura
Masanori
M
Ismail
Tevfik F
TF
Naruse
Hiroyuki
H
Hattori
Kousuke
K
Kan
Shino
S
Ishikawa
Makoto
M
Kawai
Tomoko
T
Takagi
Yasushi
Y
Ishii
Junichi
J
Prati
Francesco
F
Serruys
Patrick W
PW
D000368:Aged; D001807:Blood Vessel Prosthesis; D019917:Blood Vessel Prosthesis Implantation / Q000379:methods; D023903:Coronary Restenosis / Q000000981:diagnostic imaging / Q000517:prevention & control*; D003328:Coronary Thrombosis / Q000000981:diagnostic imaging / Q000517:prevention & control; D054855:Drug-Eluting Stents; D005260:Female; D006083:Graft Occlusion, Vascular / Q000000981:diagnostic imaging / Q000209:etiology; D006801:Humans; D007166:Immunosuppressive Agents / Q000008:administration & dosage*; D008297:Male; D008875:Middle Aged; D011475:Prosthesis Failure; D011859:Radiography; D020123:Sirolimus / Q000008:administration & dosage*; D041623:Tomography, Optical Coherence; D018084:Ultrasonography, Interventional
D007166:Immunosuppressive Agents; D020123:Sirolimus