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Interventional cardiology
Optical coherence tomography assessment of the acute effects of stent implantation on the vessel wall: a systematic quantitative approach
  1. N Gonzalo,
  2. P W Serruys,
  3. T Okamura,
  4. Z J Shen,
  5. Y Onuma,
  6. H M Garcia-Garcia,
  7. G Sarno,
  8. C Schultz,
  9. R J van Geuns,
  10. J Ligthart,
  11. E Regar
  1. Thoraxcenter, Erasmus MC, Erasmus University, Rotterdam, The Netherlands
  1. Correspondence to Dr E Regar, Thoraxcenter, Erasmus MC, Bd 585, ‘s-Gravendijkwal 230, 3015-CE Rotterdam, The Netherlands; e.regar{at}erasmusmc.nl

Abstract

Objective: To observe and characterise vessel injury after stenting using optical coherence tomography (OCT), to propose a systematic OCT classification for periprocedural vessel trauma, to evaluate its frequency in stable versus unstable patients and to assess its clinical impact during the hospitalisation period.

Setting: Stenting causes vessel injury.

Design and interventions: All consecutive patients in whom OCT was performed after stent implantation were included in the study. Qualitative and quantitative assessment of tissue prolapse, intra-stent dissection and edge dissection were performed.

Results: Seventy-three patients (80 vessels) were analysed. Tissue prolapse within the stented segment was visible in 78/80 vessels (97.5%). Median number of tissue prolapse sites was 8 (IQR 4–19), mean (SD) area 1.04 (0.9) mm2. Intra-stent dissection flaps were visible in 69/80 vessels (86.3%) (median number 3 (IQR 1.25–6), maximum flap length 450 (220) μm). Fifty-five out of 80 vessels (68.8%) showed dissection cavities (median number 2 (IQR 0–4.75), maximum depth 340 (170) μm). Edge dissection was visible in 20 vessels (mean (SD) length flap 744 (439) μm). The frequency of tissue prolapse or intra-stent dissection was similar in stable and unstable patients (95.6% vs 100%, p = 0.5 for tissue prolapse; 91.1% vs 82.9%, p = 0.3 for intra-stent dissection). There were no events during the hospitalisation period.

Conclusions: OCT allows a detailed visualisation of vessel injury after stent implantation and enables a systematic classification and quantification in vivo. In this study, frequency of tissue prolapse or intra-stent dissections after stenting was high, irrespective of the clinical presentation of the patients, and was not associated with clinical events during hospitalisation.

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Footnotes

  • Competing interests None.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • See Editorial, p 1895

  • Patient consent Obtained.

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