title: Suboptimal stent deployment is associated with subacute stent thrombosis: optical coherence tomography insights from a multicenter matched study. From the CLI Foundation investigators: the CLI-THRO study.
abstract: BACKGROUND
  Acute or subacute stent thrombosis (ST) is a well-described complication usually causing acute coronary syndromes and, in the worst case scenario, sudden cardiac death. In this study, we aimed at exploring the potential role of optical coherence tomography (OCT) in the understanding of the mechanism of ST.
  
  
  METHODS
  Twenty-one consecutive patients, after acute coronary syndromes due to a definite subacute ST, were assessed with OCT and matched 1:2 with 42 patients undergoing OCT for scheduled follow-up. Optical coherence tomography assessment was focused on features indicative of nonoptimal stent deployment: underexpansion, malapposition, edge dissection, and reference lumen narrowing.
  
  
  RESULTS
  Optical coherence tomography revealed a minimum stent area sensibly smaller in the ST group (5.6 ± 2.6 vs 6.8 ± 1.7 mm(2); P = .03) with a higher incidence of stent underexpansion when compared with the control group (42.8% vs 16.7%; P = .05). Dissection at stent edges was more commonly detected in ST group (52.4% vs 9.5%; P < .01). No significant differences between the 2 groups were observed for malapposition (52.4% vs 38.1%; P = .651) and reference lumen narrowing (19.0% vs 4.8%; P = .172). At least 1 OCT finding indicative of suboptimal stent deployment was detectable in 95.2% of patients experiencing ST versus 42.9% of the control group (P < .01).
  
  
  CONCLUSIONS
  Optical coherence tomography assessment in patients experiencing subacute ST revealed nonoptimal stent deployment in almost all cases with higher incidence of stent underexpansion and edge dissection, potentially explaining the cause of this adverse event. The adoption of an OCT-guided percutaneous coronary intervention protocol could have a potential for the prevention of ST in complex cases.
authors: San Giovanni Hospital, Rome, Italy; CLI Foundation, Rome, Italy. Electronic address: fprati@hsangiovanni.roma.it.
authors: Francesco
authors: F
authors: Prati
authors: IRCCS Foundation, Policlinico San Matteo, Pavia, Italy.
authors: Takahide
authors: T
authors: Kodama
authors: CLI Foundation, Rome, Italy.
authors: Enrico
authors: E
authors: Romagnoli
authors: San Giovanni Hospital, Rome, Italy; CLI Foundation, Rome, Italy.
authors: Laura
authors: L
authors: Gatto
authors: San Giovanni Hospital, Rome, Italy.
authors: Luca
authors: L
authors: Di Vito
authors: San Giovanni Hospital, Rome, Italy.
authors: Vito
authors: V
authors: Ramazzotti
authors: CLI Foundation, Rome, Italy.
authors: Alberto
authors: A
authors: Chisari
authors: CLI Foundation, Rome, Italy.
authors: Valeria
authors: V
authors: Marco
authors: GVM Care and Research, E S Health Science Foundation, Cotignola, Italy.
authors: Alberto
authors: A
authors: Cremonesi
authors: Careggi Hospital, Florence, Italy.
authors: Guido
authors: G
authors: Parodi
authors: San Giovanni Hospital, Rome, Italy; CLI Foundation, Rome, Italy.
authors: Mario
authors: M
authors: Albertucci
authors: Hospital Universitario de la Princesa, IIS-IP, Madrid, Spain.
authors: Fernando
authors: F
authors: Alfonso
mesh_terms: D054058:Acute Coronary Syndrome / Q000209:etiology / Q000473:pathology / Q000503:physiopathology / Q000601:surgery; D000368:Aged; D016022:Case-Control Studies; D017023:Coronary Angiography / Q000379:methods; D003324:Coronary Artery Disease / Q000175:diagnosis / Q000628:therapy; D020878:Device Removal / Q000379:methods*; D019544:Equipment Failure Analysis; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D017063:Outcome Assessment, Health Care; D062072:Patient Acuity; D062645:Percutaneous Coronary Intervention / Q000009:adverse effects / Q000295:instrumentation / Q000379:methods; D011183:Postoperative Complications / Q000209:etiology / Q000473:pathology / Q000503:physiopathology / Q000601:surgery; D011446:Prospective Studies; D015203:Reproducibility of Results; D015607:Stents / Q000009:adverse effects*; D041623:Tomography, Optical Coherence / Q000379:methods*