Abstract

Objective: To observe and characterise vessel injury post-stenting using optical coherence tomography (OCT), to propose a systematic OCT classification for periprocedural vessel trauma, to evaluate its frequency in stable vs unstable patients and to assess its clinical impact during the hospitalization 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, intrastent dissection and edge dissection were performed.

Results: Seventy-three patients (80 vessels) were analyzed. Tissue prolapse within the stented segment was visible in 78/80 vessels (97.5%). Median number of tissue prolapse sites was 8 [Interquartile (IQ) range 4-19], mean area 1.04±0.9 mm². Intrastent dissection flaps were visible in 69/80 vessels (86.2%) (median number 3 (IQ range1.25-6), maximum flap length 450±220 µm). Fifty-five out of 80 vessels (68.7%) showed dissection cavities (median number 2 (IQ range 0-4.75), maximum depth 340±170 µm). Edge dissection was visible in 20 vessels (mean length flap 744±439 µm).

The frequency of tissue prolapse or intrastent dissection was not different between stable and unstable patients (95.6vs100% p=0.5 for tissue prolapse, 91.1vs82.9% p=0.3 for intrastent dissection). There were no events during the hospitalization period.

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