Abstract 13271: Incidence of Stent Complications detected by Optical Coherence Tomography and their Clinical Significance: One Year Follow up Study

Introduction: Optical coherence tomography (OCT) was introduced to optimize percutaneous coronary intervention (PCI). Due to its unprecedented resolution, complications are frequently visualized. The exact incidence and clinical significance of these OCT detected complications are unknown. Object: The aims of this study were 1) to evaluate the incidence of acute stent complications by OCT, 2) to correlate these complications with clinical outcome at 1 year, and 3) to identify the OCT predictors for major adverse cardiac events (MACE) including death, acute myocardial infarction (AMI), stent thrombosis, and target lesion revascularizations (TLR). Methods and Results: A total of 409 patients with 473 drug eluting stents (DES) who had post stent OCT imaging were included in this study. The incidence of stent edge dissection was 36.4% and of intra stent dissection was 72.3%. Incomplete stent apposition was detected in 36.4% of stents. The incidence of smooth protrusion, fibrous flap or disrupted fibrous plaque, irregular protrusion and thrombus were 93.7%, 56.0%, 55.2%, and 33.4%, respectively. Minimal stent underexpansion defined by minimal stent area (MSA) < 1.0 of reference area and severe stent underexpansion defined by MSA< 0.8 of reference area were observed in 84.8% and 37.8% of stents. MACE occurred in 3.7% of cases at 1 year follow up. There was no death. AMI, stent thrombosis, and TLR occurred in 0.7%, 0.2%, and 3.2%. Univariate analysis showed small MSA (MSA< 5 mm2) and irregular protrusion were correlated with MACE at 1year follow up (P=0.003 and P=0.044). Following adjustment of stent edge dissection, incomplete stent apposition, irregular protrusion, small MSA, stent type, and clinical presentations, small MSA and irregular protrusion remain as independent predictors of MACE (P=0.004 and P=0.037). Conclusions: OCT-detected stent complication rate is high. Small MSA and irregular protrusion are independent predictors of MACE at 1 year.

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Clinical significance of healed plaque detected by optical coherence tomography: a 2-year follow-up study

Journal of Thrombosis and Thrombolysis ◽

10.1007/s11239-020-02076-w ◽

2020 ◽

Vol 50 (4) ◽

pp. 895-902 ◽

Cited By ~ 2

Author(s):

Osamu Kurihara ◽

Michele Russo ◽

Hyung Oh Kim ◽

Makoto Araki ◽

Hiroki Shinohara ◽

...

Keyword(s):

Optical Coherence Tomography ◽

Clinical Significance ◽

Optical Coherence ◽

Follow Up Study

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ANALYSIS OF IN-STENT RESTENOSIS PATTERN BY OPTICAL COHERENCE TOMOGRAPHY: INPACT OF DIFFERENCE IN STENT TYPE AND FOLLOW-UP PERIOD

Journal of the American College of Cardiology ◽

10.1016/s0735-1097(10)61902-x ◽

2010 ◽

Vol 55 (10) ◽

pp. A202.E1901

Author(s):

Ippei Kosedo ◽

Shingo Hosogi ◽

Yuki Tsujimoto ◽

Kentaro Shibayama ◽

Naoki Saito ◽

...

Keyword(s):

Optical Coherence Tomography ◽

Optical Coherence ◽

Stent Restenosis ◽

Stent Type ◽

In Stent Restenosis

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PREVALENCE AND CLINICAL SIGNIFICANCE OF LIPID-RICH PLAQUE DETECTED BY OPTICAL COHERENCE TOMOGRAPHY: A FOUR-YEAR FOLLOW-UP STUDY

Journal of the American College of Cardiology ◽

10.1016/s0735-1097(17)34364-4 ◽

2017 ◽

Vol 69 (11) ◽

pp. 975 ◽

Cited By ~ 5

Author(s):

Lei Xing ◽

Takumi Higuma ◽

Zhao Wang ◽

Aaron Aguirre ◽

Shaosong Zhang ◽

...

Keyword(s):

Optical Coherence Tomography ◽

Clinical Significance ◽

Optical Coherence ◽

Follow Up Study ◽

Lipid Rich Plaque

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Assessment of stent optimization in clinical practice using optical coherence tomography: a multicentric observational study

European Heart Journal ◽

10.1093/eurheartj/ehab724.0275 ◽

2021 ◽

Vol 42 (Supplement_1) ◽

Author(s):

H Rai ◽

F Harzer ◽

L Raeber ◽

D M Leistner ◽

F Alfonso ◽

...

Keyword(s):

Optical Coherence Tomography ◽

Lower Incidence ◽

Coronary Calcification ◽

Adaptive Lasso ◽

Segment Length ◽

Optical Coherence ◽

Reference Area ◽

Coronary Syndrome ◽

Stent Expansion

Abstract Background Stent under-expansion obtained at the time of percutaneous coronary intervention (PCI) has been shown to be associated with worse outcomes. Purpose We sought to define OCT assessed optimal stent expansion index which associates with lower incidence of major adverse cardiac events (MACE) during follow-up in a sample of patients stented at five high volume centers of central Europe. Methods We analyzed 370 lesions stented during the period between 2012 and 2018, with their final procedural results imaged using optical coherence tomography (OCT). QIvus Research Edition v3.1 (Medis, Leiden, NL) was used for OCT analysis. The stented segment was split in two equal halves. Stent expansion index (SEI) was calculated for both halves separately by dividing minimum stent area by the mean reference lumen area [(proximal reference area + distal reference area)/2]. Smallest of the two prevailed as the SEI of that case. MACE during post-PCI follow-up was defined as composite of all-cause death, myocardial infarction, stent thrombosis and target lesion revascularization. Data is expressed as mean±SD or median (Interquartile range). Incidence of subsequent MACE is expressed as crude rates (%). Results A total of 316 cases (370 lesions), aged 64.6±11.7 years were included for OCT analysis. Of them, 78.8% were males, 22.8% were diabetics, 75.9% were hypertensives while 35.1% had family history of coronary artery disease. 38.0% of the cases had acute coronary syndrome at presentation. 62.4% of treated lesions were complex (Type B2/C). A mean of 1.11±0.34 stents/scaffolds were implanted per treated lesion. Analyzed segment length was 20.4 (15.17, 27.0) mm. Minimal stent area (MSA) in the overall stented segment was 6.02 mm2 (4.65, 7.93). Median stent expansion index (minimum) was 0.79 (0.71, 0.86). Median follow-up duration was 557 days (326, 1,096). 47 lesions (12.7%) suffered MACE during follow-up. Receiver operating characteristic (ROC) curve analysis using Youden's rule identified 0.84 as SEI cut-off powered to predict post-PCI MACE (AUC= 0.60, sensitivity= 0.85, specificity= 0.34). MACE was observed in 38/249 (15.3%) of lesions with SEI≤0.84 and in 9/121 (7.4%) of lesions with SEI>0.84 (p=0.03). Univariate regression analysis of MACE revealed significant association with SEI≤0.84 (OR=2.2, 95% CI=1.1–4.8, p=0.04) Adaptive Lasso regression identified SEI≤0.84 (OR=4.1, 95% CI=1.3–12.6, p=0.02) and coronary calcification at baseline (OR=2.7, 95% CI=1.1–6.6, p=0.03) as independent predictors of MACE during follow-up. Kaplan-meier curve for MACE free survival with optimal SEI (n=121) and sub-optimal SEI (n=249) subgroups using SEI cut-off of 0.84, however showed modest separation (p=0.11). Conclusions The present study identified SEI>0.84 associated with lower incidence of MACE as optimal cut-off in daily practice. Along with SEI of ≤0.84, coronary calcification was also significantly associated with MACE during post PCI follow-up. FUNDunding Acknowledgement Type of funding sources: None.

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P5624Late acquired tissue protrusion after drug-eluting stent implantation: a serial follow-up of 1-month optical coherence tomography imaging

European Heart Journal ◽

10.1093/eurheartj/ehz746.0568 ◽

2019 ◽

Vol 40 (Supplement_1) ◽

Author(s):

M Otagaki ◽

K F Fujii ◽

K M Matsumura ◽

T N Noda ◽

H S Shibutani ◽

...

Keyword(s):

Optical Coherence Tomography ◽

Stent Thrombosis ◽

Stent Implantation ◽

Subsequent Development ◽

Drug Eluting Stent ◽

Plaque Morphology ◽

Optical Coherence ◽

Short Term ◽

Stent Restenosis

Abstract Background Tissue protrusion (TP) between the stent struts after stent implantation has been implicated as a potential factor in the subsequent development of stent thrombosis. However, the incidence, natural history, and predictive factor of TP after stent implantation remains unclear. Purpose To elucidate the fate of TP, we undertook the study assessing TP using short term serial optical coherence tomography (OCT), immediately after deployment of stents and at 1-month follow-up. Methods This was a prospective, single-center study evaluating vascular healing responses with OCT both immediately after and at 1-month after biodegradable-polymer sirolimus-eluting stent (SES) implantation. A total of 18 stable angina patients having OCT-guided PCI with SESs underwent assessment of TP with OCT pre-procedure, post-procedure, and at 1-month follow-up. TP was defined as a tissue prolapse for more than 200 μm between stent struts that directly correlates with the underlying plaque, without abrupt transition and different optical properties. TP was classified into the following 3 groups on the basis of serial assessment: (1) healed, TP present after the procedure but covered by tissue with smooth surface at 1-month follow-up; (2) persistent, TP present both after the procedure and 1-month follow-up; and (3) late-acquired, TP not present at baseline but present at 1-month follow-up. Results Immediately after the procedure, 29 TPs in 13 patients (72%) were identified. Of those, 16 (55%) were healed and 13 (45%) were persistent at 1-month follow-up. Although the size of TP on post-procedural OCT was similar, neointimal area in lesions with healed TP was significantly larger than in lesions with persistent TP due to neointimal proliferation at 1-month follow-up. A synchronous comparison between the post-procedural OCT and the follow-up OCT image showed that 5 TPs were observed only at 1-month follow-up (late-acquired). In lesions with late-acquired TP, calcified nodule or thin-cap fibroatheroma was identified as an underlying plaque morphology on pre-procedural OCT. A representative example is presented in Figure. Incidence of TP and representative case Conclusion Short term serial OCT analysis found that TP can occur not only immediately after SES implantation, but also 1 month after SES implantation. This new concept may provide a new insight into the mechanism of in-stent restenosis and stent thrombosis development after stent implantation. Acknowledgement/Funding None

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P5628Resolution of incomplete stent apposition in the early phase after stent implantation: serial optical coherence tomography analyses at 2-week and 4-month

European Heart Journal ◽

10.1093/eurheartj/ehz746.0572 ◽

2019 ◽

Vol 40 (Supplement_1) ◽

Author(s):

M Shimoda ◽

H Ando ◽

H Takashima ◽

K Waseda ◽

S Sakurai ◽

...

Keyword(s):

Optical Coherence Tomography ◽

Early Phase ◽

Second Generation ◽

Curve Analysis ◽

Natural Course ◽

Receiver Operating Curve ◽

Optical Coherence ◽

Roc Curve Analysis ◽

Incomplete Stent Apposition

Abstract Background Previous optical coherence tomography (OCT) study demonstrated that the incomplete stent apposition (ISA) distance <355 μm immediately after an index procedure was the corresponding cut-off point for predicting the resolution of ISA at 8–12 months follow-up in the second-generation DES. However, the natural course of acute ISA in the earlier phase remains unknown. The aim of the present study is to evaluate the natural course of acute ISA in the early phase after second-generation everolimus-eluting stent (EES) using serial OCT analyses at 2-week and 4-month. Methods From the population of the ACS-OCT trial, we identified a total of 45 patients who successfully underwent serial OCT examinations at post-stenting, 2-week follow-up, and 4-month follow-up. The presence of ISA was assessed in the OCT images, and ISA distance was measured within the stented segment. The target site for OCT analysis was the cross-section at the proximal edge of implanted stent. Serial OCT images at post-stenting, 2-week follow-up and 4-month follow-up were reviewed side by side on the screen, and maximum ISA distance and cross-sectional ISA area were measured. Results Incomplete stent apposition was observed in all EES at post-stenting, and it was persistent in 37.8% at 2-week follow-up and 11.1% at 4-month follow-up. Maximum ISA distance was significantly decreased over time (post-stenting, 144±150mm; 2-week follow-up, 88±146mm; 4-month follow-up, 34±111mm). Receiver-operating curve analysis identified that the best cut-off value of OCT-estimated ISA distance at post-stenting for predicting persistent ISA at 2-week follow-up and 4-month follow-up was >140μm and >215μm, respectively. ROC curve analysis Conclusion ISA distance at post-stenting is an useful predictor for the resolution of ISA in the early phase after EES implantation.

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Inner Retinal Morphology and Visual Outcomes in Idiopathic Epiretinal Membrane Surgery: A Retrospective Optical Coherence Tomography Study

Journal of VitreoRetinal Diseases ◽

10.1177/2474126421989614 ◽

2021 ◽

pp. 247412642198961

Author(s):

Ioannis S. Dimopoulos ◽

Michael Dollin

Keyword(s):

Optical Coherence Tomography ◽

Epiretinal Membrane ◽

Strong Predictor ◽

Plexiform Layer ◽

Inner Plexiform Layer ◽

Optical Coherence ◽

Visual Outcomes ◽

Retinal Pathology

Purpose: Epiretinal membrane (ERM) is a common retinal finding for patients older than 50 years. Disorganization of the retinal inner layers (DRIL) has emerged as a novel predictor of poor visual acuity (VA) in eyes with inner retinal pathology. The aim of our study is to correlate preoperative DRIL with visual outcomes after ERM surgery. Methods: Medical records and optical coherence tomography (OCT) images of 81 pseudophakic patients who underwent treatment of idiopathic ERM were reviewed. Preoperative DRIL on OCT was correlated with VA at baseline and at 3 and 6 months after ERM surgery. DRIL was defined as the loss of distinction between the ganglion cell–inner plexiform layer complex, inner nuclear layer, and outer plexiform layer. DRIL severity was based on its extent within the central 2-mm region of a transfoveal B-scan (absent/mild: <one-third, severe: >one-third horizontal width). Results: Review of preoperative OCT showed severe DRIL in 41% and absent/mild DRIL in 59%. Severe DRIL was associated with worse baseline VA ( P < .001). Preoperative VA and DRIL status at baseline were both predictors of postoperative VA at follow-up time points ( P < .001). Severe DRIL was associated with significantly less improvement in VA at 6 months (–0.23 logMAR for absent/mild vs –0.14 for severe DRIL). Conclusions: Presence of severe preoperative DRIL correlates with worse baseline VA in patients with ERM and reduced VA improvement at 6 months. DRIL can be a strong predictor of long-term poor visual outcomes in ERM surgery.

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The Use of Anterior-Segment Optical-Coherence Tomography for the Assessment of the Iridocorneal Angle and Its Alterations: Update and Current Evidence

Journal of Clinical Medicine ◽

10.3390/jcm10020231 ◽

2021 ◽

Vol 10 (2) ◽

pp. 231

Author(s):

Giacinto Triolo ◽

Piero Barboni ◽

Giacomo Savini ◽

Francesco De Gaetano ◽

Gaspare Monaco ◽

...

Keyword(s):

Optical Coherence Tomography ◽

Intraocular Pressure ◽

Clinical Relevance ◽

Anterior Segment ◽

Angle Closure ◽

Current Evidence ◽

Optical Coherence ◽

Iridocorneal Angle ◽

Wide Range

The introduction of anterior-segment optical-coherence tomography (AS-OCT) has led to improved assessments of the anatomy of the iridocorneal-angle and diagnoses of several mechanisms of angle closure which often result in raised intraocular pressure (IOP). Continuous advancements in AS-OCT technology and software, along with an extensive research in the field, have resulted in a wide range of possible parameters that may be used to diagnose and follow up on patients with this spectrum of diseases. However, the clinical relevance of such variables needs to be explored thoroughly. The aim of the present review is to summarize the current evidence supporting the use of AS-OCT for the diagnosis and follow-up of several iridocorneal-angle and anterior-chamber alterations, focusing on the advantages and downsides of this technology.

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