Optical coherence tomography-guided management of underexpanded stent in calcified coronary lesion

2021 ◽  
Vol 14 (1) ◽  
pp. e239143
Author(s):  
Ankush Gupta ◽  
Sanya Chhikara ◽  
Navreet Singh ◽  
Krishna Prasad
Keyword(s):  
Optical Coherence Tomography ◽  
Coronary Intervention ◽  
Anterior Wall ◽  
Optical Coherence ◽  
Initial Management ◽  
Ultra High Pressure ◽  
Stent Expansion ◽  
Increased Risk ◽  
Percutaneous Coronary ◽  
Drug Eluting

Calcified lesions often result in undilatable lesions, balloon dog-boning, poor device delivery as well as underexpanded stents (UES). This leads to an increased risk of acute and chronic stent failure. A 49-year-old man was admitted with anterior wall myocardial infarction and angiogram showed a diffuse calcific left anterior descending artery/diagonal lesion, which was stented with two overlapping drug-eluting stents. Angiogram after post-dilatation showed UES. Optical coherence tomography (OCT) confirmed UES with 58% expansion, minimum stent area (MSA) of 2.91 mm2 and 360° calcium arc around the stent. This UES was dilated with a ultra high-pressure balloon (UHPB) at 40 atmosphere, that led to calcium fracture and increased MSA to 7.42 mm2 and stent expansion to 97%. While OCT-guided lesion modification prior to stenting is ideal, OCT-guided assessment and management is also invaluable post-percutaneous coronary intervention. In the event of stent underexpansion, UHPB may be used as an initial management strategy.

Optical Coherence Tomography Assessment of the Effect of High-pressure Non-compliant Balloon Postdilation on Underexpansion and Malapposition in Drug-eluting Stents

2011 ◽  
Vol 6 (2) ◽  
pp. 110
Author(s):  
Tom Adriaenssens ◽  
Giovanni J Ughi ◽  
Jan Dhooge ◽  
Walter Desmet ◽  
◽  
...  
Keyword(s):  
High Pressure ◽  
Optical Coherence Tomography ◽  
Coronary Intervention ◽  
Drug Eluting Stents ◽  
Optical Coherence ◽  
Cross Sectional ◽  
Incomplete Stent Apposition ◽  
Increased Risk ◽  
Human Pathology ◽  
Drug Eluting

Concerns of an increased risk of thrombosis in drug-eluting stents (DES) and the association, in human pathology studies of stent thrombosis, of delayed healing with malapposition of stent struts has fostered a renewed interest in stent implantation optimisation techniques. We investigated the rationale of the use of optical coherence tomography (OCT), an intravascular imaging technique with 10-fold better resolution than intravascular ultrasound (IVUS), in the guidance of percutaneous coronary intervention (PCI) with respect to the correction of stent underexpansion and malapposition in DES. In 12 patients with OCT characteristics of frank malapposition immediately after DES implantation, high-pressure postdilation with a non-compliant balloon was performed. We concluded that high-pressure non-compliant balloon postdilation for underexpansion and malapposition in DES significantly improves minimal stent diameter (MSD) and minimum cross-sectional area (CSA), as assessed with OCT. There was a highly significant decrease in the percentage of malapposed struts. Larger series, correlated with OCT and clinical follow-up, will shed light on the clinical implications of postdilation in case of severe acute incomplete stent apposition (ISA).

Percutaneous coronary intervention

2020 ◽  
pp. 183-252
Author(s):  
Andrew Mitchell ◽  
Giovanni Luigi De Maria ◽  
Adrian Banning
Keyword(s):  
Optical Coherence Tomography ◽  
Percutaneous Coronary Intervention ◽  
Coronary Intervention ◽  
Drug Eluting Stents ◽  
Optical Coherence ◽  
Percutaneous Coronary Intervention Procedure ◽  
Percutaneous Coronary ◽  
History Of ◽  
Drug Eluting ◽  
Intervention Procedure

This chapter covers percutaneous coronary intervention. It starts with the history of the procedure, indications, and techniques for imaging the lesion, and describes different systems of lesion classification. The equipment required for percutaneous coronary intervention, including guiding catheters, angioplasty guide wires, angioplasty balloons, and intracoronary stents (drug-eluting stents, bioabsorbable scaffolds, etc.) are all covered. The percutaneous coronary intervention procedure is then explained. Intravascular ultrasound is compared and contrasted to optical coherence tomography. Antiplatelet and anticoagulant therapies are described in detail, and finally specific techniques in complex PCI are covered.

scholarly journals The role of optical coherence tomography guidance in scaffold versus stent optimization

2020 ◽  
Vol 72 (1) ◽  
Author(s):  
Arif A. Al Nooryani ◽  
Nagwa A. Abdelrahman ◽  
Hatem A. Helmy ◽  
Yehia T. Kishk ◽  
Ayman K. M. Hassan
Keyword(s):  
Decision Making ◽  
Optical Coherence Tomography ◽  
Coronary Intervention ◽  
Drug Eluting Stents ◽  
Optical Coherence ◽  
Total Rate ◽  
Great Ability ◽  
Bioresorbable Scaffolds ◽  
Drug Eluting ◽  
The Impact

Abstract Background Optical coherence tomography showed a great ability to identify adverse features during percutaneous coronary intervention with drug-eluting stents and resulted in better clinical outcomes. The study aimed to assess the impact of optical coherence tomography on intraoperative decision-making during implantation of Absorb bioresorbable scaffolds versus everolimus drug-eluting stents. Results We performed an observational study that included 223 consecutive patients post optical coherence tomography-guided implantation of either Absorb bioresorbable scaffolds (162 patients) or everolimus drug-eluting stents (61 patients). We studied the influence of optical coherence tomography on intraoperative decision-making during implantation of bioresorbable scaffolds versus drug-eluting stents by analyzing the total rate of optical coherence tomography-dependent modifications in each device. After satisfactory angiographic results, the total rate of required intervention for optical coherence tomography detected complications was significantly higher in the bioresorbable scaffolds arm compared to drug-eluting stents arm (47.8% versus 32.9%, respectively; p = 0.019). The additional modifications encompassed further optimization in the case of device underexpansion or struts malapposition, and even stenting in the case of strut fractures, or significant edge dissection. Conclusions Compared to drug-eluting stents, Absord scaffold was associated with a significantly higher rate of optical coherence tomography-identified intraprocedural complications necessitating further modifications. The study provides some hints on the reasons of scaffolds failure in current PCI practice; it offers a new insight for the enhancement of BRS safety and presents and adds to the growing literature for successful BRS utilization.

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