title: Combined use of optical coherence tomography and intravascular ultrasound imaging in patients undergoing coronary interventions for stent thrombosis.
abstract: OBJECTIVE
  This prospective study sought to assess the diagnostic value of optical coherence tomography (OCT) compared with intravascular ultrasound (IVUS) in patients presenting with stent thrombosis (ST).
  
  
  METHODS
  Although the role of IVUS in this setting has been described, the potential diagnostic value of OCT in patients suffering ST remains poorly defined. Catheterization Laboratory, University Hospital.
  
  
  METHODS
  Fifteen consecutive patients with ST undergoing rescue coronary interventions under combined IVUS/OCT imaging guidance were analysed.
  
  
  METHODS
  Analysis and comparison of OCT and IVUS findings before and after interventions.
  
  
  RESULTS
  Before intervention, OCT visualised the responsible thrombus in all patients (thrombus area 4.7±2.5 mm(2), stent obstruction 82±14%). Minimal stent area was 4.7±2.1 mm(2) leading to severe stent underexpansion (expansion 60±21%). Although red or mixed thrombus (14 patients) induced partial strut shadowing (total length 12.3±6 mm), malapposition (six patients), inflow-outflow disease (five patients), uncovered struts (nine patients) and associated in-stent restenosis (five patients, four showing neoatherogenesis) was clearly recognised. IVUS disclosed similar findings but achieved poorer visualisation of thrombus-lumen interface and strut malapposition, and failed to recognise uncovered struts and associated neoatherosclerosis. After interventions, OCT demonstrated a reduced thrombus burden (2.4±1.6 mm(2)) and stent obstruction (24±14%) with improvements in stent area (6.8±2.9 mm(2)) and expansion (75±21%) (all p<0.05). IVUS and OCT findings proved to be complementary.
  
  
  CONCLUSIONS
  OCT provides unique insights on the underlying substrate of ST and may be used to optimise results in these challenging interventions. In this setting, OCT and IVUS have complementary diagnostic values.
authors: Department of Interventional Cardiology, Cardiovascular Institute, Clínico San Carlos University Hospital, Madrid, Spain. falf@hotmail.com
authors: Fernando
authors: F
authors: Alfonso
authors: Jaime
authors: J
authors: Dutary
authors: Manuel
authors: M
authors: Paulo
authors: Nieves
authors: N
authors: Gonzalo
authors: Maria J
authors: MJ
authors: Pérez-Vizcayno
authors: Pilar
authors: P
authors: Jiménez-Quevedo
authors: Javier
authors: J
authors: Escaned
authors: Camino
authors: C
authors: Bañuelos
authors: Rosana
authors: R
authors: Hernández
authors: Carlos
authors: C
authors: Macaya
mesh_terms: D000368:Aged; D015906:Angioplasty, Balloon, Coronary / Q000009:adverse effects / Q000295:instrumentation*; D016009:Chi-Square Distribution; D017023:Coronary Angiography; D023903:Coronary Restenosis / Q000175:diagnosis / Q000209:etiology / Q000628:therapy; D003328:Coronary Thrombosis / Q000175:diagnosis* / Q000209:etiology / Q000628:therapy*; D003331:Coronary Vessels / Q000000981:diagnostic imaging* / Q000473:pathology*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D011237:Predictive Value of Tests; D011446:Prospective Studies; D012720:Severity of Illness Index; D013030:Spain; D015607:Stents; D041623:Tomography, Optical Coherence; D016896:Treatment Outcome; D018084:Ultrasonography, Interventional