title: Optical coherence tomography after carotid stenting: rate of stent malapposition, plaque prolapse and fibrous cap rupture according to stent design.
abstract: OBJECTIVE
  This study aims to evaluate the rate of stent malapposition, plaque prolapse and fibrous cap rupture detected by optical coherence tomography (OCT) imaging according to carotid stent design.
  
  
  METHODS
  It was a prospective single-centre study.
  
  
  METHODS
  Forty consecutive patients undergoing protected carotid artery stenting (CAS) and high-definition OCT image acquisition were enrolled in the study. OCT frames were analysed off-line, in a dedicated core laboratory by two independent physicians. Cross-sectional OCT images within the stented segment of the internal carotid artery were evaluated at 1-mm intervals for the presence of strut malapposition, plaque prolapse and fibrous cap rupture according to stent design.
  
  
  RESULTS
  Closed-cell design stents (CC) were used in 17 patients (42.5%), open-cell design stents (OC) in 13 (32.5%) and hybrid design stents (Hyb) in 10 (25%). No procedural or post-procedural neurological complications occurred (stroke/death 0% at 30 days). On OCT analysis the frequencies of malapposed struts were higher with CC compared to OC and Hyb (34.5% vs 15% and 16.3%, respectively; p < 0.01). Plaque prolapse was more frequent with OC vs CC (68.6% vs 23.3%; p < 0.01) and vs Hyb stents (30.8%; p < 0.01). Significant differences were also noted in the rates of fibrous cap rupture between CC and OC (24.2% vs 43.8%; p < 0.01), and between CC and Hyb (24.2% vs 39.6%; p < 0.01), but not between OC and Hyb stents (p = 0.4).
  
  
  CONCLUSIONS
  Intravascular OCT after CAS revealed that micro-defects after stent deployment are frequent and are related to the design of implanted stents. Stent malapposition is more frequent with CC stents, while plaque prolapse is more common with OC stents. It remains, however, unknown whether these figures now detected with OCT are of any clinical and prognostic significance.
authors.affiliation: Department of Surgery, Vascular and Endovascular Surgery Unit, University of Siena, Siena, Italy. dedonato@unisi.it
authors.forename: G
authors.initials: G
authors.lastname: de Donato
authors.forename: F
authors.initials: F
authors.lastname: Setacci
authors.forename: P
authors.initials: P
authors.lastname: Sirignano
authors.forename: G
authors.initials: G
authors.lastname: Galzerano
authors.forename: A
authors.initials: A
authors.lastname: Cappelli
authors.forename: C
authors.initials: C
authors.lastname: Setacci
mesh_terms: D000368:Aged; D000800:Angioplasty, Balloon / Q000009:adverse effects* / Q000295:instrumentation* / Q000401:mortality; D002340:Carotid Artery Diseases / Q000150:complications / Q000401:mortality / Q000473:pathology / Q000628:therapy*; D002343:Carotid Artery, Internal / Q000473:pathology*; D016009:Chi-Square Distribution; D005260:Female; D005355:Fibrosis; D006801:Humans; D007558:Italy; D008297:Male; D058226:Plaque, Atherosclerotic; D011237:Predictive Value of Tests; D011446:Prospective Studies; D011474:Prosthesis Design; D012307:Risk Factors; D012422:Rupture, Spontaneous; D015607:Stents; D020521:Stroke / Q000209:etiology; D013997:Time Factors; D041623:Tomography, Optical Coherence; D016896:Treatment Outcome