title: Natural consequence of post-intervention stent malapposition, thrombus, tissue prolapse, and dissection assessed by optical coherence tomography at mid-term follow-up.
abstract: OBJECTIVE
  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).
  
  
  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.
  
  
  CONCLUSIONS
  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.
authors.affiliation: Division of Cardiovascular Medicine, Department of Internal Medicine, Kobe University Graduate School of Medicine, 7-5-1 Kusunoki-cho, Chuo-ku, Kobe, Hyogo 650-0017, Japan.
authors.forename: Hiroyuki
authors.initials: H
authors.lastname: Kawamori
authors.forename: Junya
authors.initials: J
authors.lastname: Shite
authors.forename: Toshiro
authors.initials: T
authors.lastname: Shinke
authors.forename: Hiromasa
authors.initials: H
authors.lastname: Otake
authors.forename: Daisuke
authors.initials: D
authors.lastname: Matsumoto
authors.forename: Masayuki
authors.initials: M
authors.lastname: Nakagawa
authors.forename: Ryoji
authors.initials: R
authors.lastname: Nagoshi
authors.forename: Amane
authors.initials: A
authors.lastname: Kozuki
authors.forename: Hirotoshi
authors.initials: H
authors.lastname: Hariki
authors.forename: Takumi
authors.initials: T
authors.lastname: Inoue
authors.forename: Tsuyoshi
authors.initials: T
authors.lastname: Osue
authors.forename: Yu
authors.initials: Y
authors.lastname: Taniguchi
authors.forename: Ryo
authors.initials: R
authors.lastname: Nishio
authors.forename: Noritoshi
authors.initials: N
authors.lastname: Hiranuma
authors.forename: Ken-ichi
authors.initials: K
authors.lastname: Hirata
mesh_terms: D000368:Aged; D000787:Angina Pectoris / Q000628:therapy*; D054855:Drug-Eluting Stents / Q000009:adverse effects*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D017239:Paclitaxel / Q000008:administration & dosage; D062645:Percutaneous Coronary Intervention; D011183:Postoperative Complications / Q000175:diagnosis*; D011391:Prolapse; D011475:Prosthesis Failure; D012189:Retrospective Studies; D012680:Sensitivity and Specificity; D020123:Sirolimus / Q000008:administration & dosage; D013927:Thrombosis / Q000175:diagnosis* / Q000209:etiology; D041623:Tomography, Optical Coherence
chemical_list: D017239:Paclitaxel; D020123:Sirolimus
keywords: Optical coherence tomography; Stent edge dissection; Stent malapposition; Thrombus; Tissue prolapse