scholarly journals Coronary Stent Healing in Cancer Patients—An Optical Coherence Tomography Perspective

2021 ◽  
Vol 8 ◽  
Author(s):  
Moez Karim Aziz ◽  
Joerg Herrmann ◽  
Konstantinos Marmagkiolis ◽  
Dinu Valentin Balanescu ◽  
Teodora Donisan ◽  
...  
Keyword(s):  
Optical Coherence Tomography ◽  
Cancer Patients ◽  
Stent Thrombosis ◽  
Neointimal Hyperplasia ◽  
Drug Eluting Stent ◽  
Primary Study ◽  
Optical Coherence ◽  
Oncological Treatment ◽  
Coronary Syndrome ◽  
Risk Of Cancer

Objective: This study assessed stent healing patterns and cardiovascular outcomes by optical coherence tomography (OCT) in cancer patients after drug-eluting stent (DES) placement.Background: Cancer treatment, owing to its cytotoxic and antiproliferative effects, could delay stent healing and increase stent thrombosis risk, especially when dual antiplatelet therapy (DAPT) is discontinued early for oncological treatment. OCT can assess stent endothelialization and other healing parameters, which may provide clinical guidance in these challenging scenarios.Methods: This single-center retrospective study enrolled all cancer patients who underwent OCT for assessment of vascular healing patterns after prior DES placement from November 2009 to November 2018. Primary study endpoints were stent healing parameters, including stent coverage, apposition, degree of expansion, neointimal hyperplasia heterogeneity, in-stent restenosis, stent thrombosis, and overall survival (OS).Results: A total of 67 patients were included in this study. Mean time between DES placement and OCT evaluation was 154 ± 82 days. Stent healing matched published values for DES in non-cancer patients (P ≥ 0.063). At 1 year, the OS was 86% (95% confidence interval [CI]: 78–96%) with 0% incidence of acute coronary syndrome. Advanced cancers and active chemotherapies were associated with inferior OS (P = 0.024, hazard ratio [HR]: 3.50, 95% CI: 1.18–10.42 and P = 0.026, HR: 2.65, 95% CI: 1.13–6.22, respectively), while stent healing parameters were unassociated with OS. Forty-one patients (61%) had DAPT duration ≤6 months.Conclusions: Stent healing of contemporary DES appears similar in cancer and non-cancer patients. Cardiovascular risk of cancer patients after DES placement can be managed to facilitate timely cancer therapies, as the underlying malignancy and active chemotherapy ultimately determine survival.

scholarly journals In Vivo Optical Coherence Tomography of Very Late Drug-Eluting Stent Thrombosis Compared With Late In-Stent Restenosis

2012 ◽  
Vol 76 (2) ◽  
pp. 390-398 ◽  
Author(s):  
Shinichiro Miyazaki ◽  
Yoshikazu Hiasa ◽  
Takefumi Takahashi ◽  
Yudai Yano ◽  
Tomoko Minami ◽  
...  
Keyword(s):  
Optical Coherence Tomography ◽  
Stent Thrombosis ◽  
Drug Eluting Stent ◽  
Optical Coherence ◽  
Stent Restenosis ◽  
Drug Eluting ◽  
In Stent Restenosis

scholarly journals 736 Hazy spots: through the eye of optical coherence tomography

2021 ◽  
Vol 23 (Supplement_G) ◽  
Author(s):  
Emiliano Bianchini ◽  
Rocco Vergallo ◽  
Angela Buonpane ◽  
Marco Lombardi ◽  
Alfredo Ricchiuto ◽  
...  
Keyword(s):  
Optical Coherence Tomography ◽  
Coronary Artery ◽  
Coronary Angiography ◽  
Stent Thrombosis ◽  
Anticoagulant Therapy ◽  
Stent Implantation ◽  
Optimization Technique ◽  
Optical Coherence ◽  
Coronary Syndrome ◽  
Acute Stent Thrombosis

Abstract Aims Acute stent thrombosis after coronary artery stent placement is a rare but serious complication in percutaneous coronary intervention (PCI). Stenting culprit lesions in acute coronary syndrome (ACS) has higher risk of acute stent thrombosis than stable coronary artery disease, and many local and systemic factors may contribute to increase this risk. Tissue protrusion (TP), and in particular, plaque prolapse after PCI can play a role in acute stent thrombosis, and intra-vessel imaging is the principal instrument to identify such underlying lumen alteration after stent implantation, and guide intervention. Methods and results We report the case of a 54-year-old man with a history of hypertension, dyslipidemia, type 2 diabetes mellitus, obesity and no other relevant comorbidities in remote history, who underwent a coronary angiography for an unstable angina. A long, calcific sub-occlusion of the left anterior descending artery (LAD), which involved LAD-first diagonal branch (D1) bifurcation (Medina 1.1.1) and LAD-D2 bifurcation (Medina 1.1.0) was found. After deployment of two overlapping drug-eluting stents (DES), (ULTIMASTER TANSEI 3.0 × 38 mm and 3.0 × 21 mm) and struts apposition optimization with sequence of proximal optimization technique (POT) on D1 and D2, and a kissing balloon technique (KS) on LAD-D2 bifurcation, a ‘hazy’ in-stent image was detected right after the LAD-D2 bifurcation, suggesting an acute in-stent thrombosis, in absence of flow alteration (TIMI 3), symptoms or ECG modifications. Multiple thrombus-aspiration were made and resulted in abundant thrombus removal and improvement in the angiographic image, with persistent valid flow on every three vessels (TIMI 3). After 5 days of triple anticoagulant therapy with ticagrelor, cardioaspirin and UFH infusion, he underwent a new coronary angiography control. A similar ‘hazy’ image was detected right after LAD-D2 bifurcation within the LAD. An optical coherence tomography (OCT) pullback was made to assess the nature of the angiographic finding. OCT showed good struts apposition in almost every cross-sectional images, but an evident TP was detected right on the angiographic hazy spot. OCT allowed to evaluate the lipid-richness of the stented plaque and the nature of the TP, which was mixed with evident both white and red thrombus apposition (minimum luminal area measured 4.5 mm2). OCT guided a new PCI, with a stent-in-stent implantation on LAD. TP was absent on the post-PCI OCT run. Conclusions In this report, we showed the usefulness of OCT in revealing a potential high risk thrombogenic source. OCT not only characterized something that angiography alone couldn’t, but suggested the etiology of the amount of thrombus removed by the vessel during the first PCI. Indeed, despite an optimized cycle of anticoagulant therapy, OCT still revealed several mixed thrombus apposition on the TP, and this suggested its role in the acute stent thrombosis. OCT guided the choice to appose a new stent-in-stent to solve a potential thrombogenic source.

scholarly journals Impact of stent edge dissection detected by optical coherence tomography after current-generation drug-eluting stent implantation

PLoS ONE ◽  
2021 ◽  
Vol 16 (11) ◽  
pp. e0259693
Author(s):  
Hiroyuki Jinnouchi ◽  
Kenichi Sakakura ◽  
Tomonobu Yanase ◽  
Yusuke Ugata ◽  
Takunori Tsukui ◽  
...  
Keyword(s):  
Optical Coherence Tomography ◽  
Clinical Outcomes ◽  
Cardiac Death ◽  
Target Lesion ◽  
Drug Eluting Stent ◽  
Primary Study ◽  
Optical Coherence ◽  
Current Generation ◽  
Drug Eluting ◽  
Inverse Probability Weighted

Background Stent edge dissection (SED) is a well-known predictor of worse clinical outcomes. However, impact of SED after current-generation drug-eluting stent (DES) implantation remains unknown since there was no study using only current-generation DES to assess impact of SED. This study aimed to investigate a relationship between SED detected by optical coherence tomography (OCT) and clinical outcomes after current-generation DES implantation. Methods This study enrolled 175 patients receiving OCT after current-generation DES implantation. The SED group was compared with the non-SED group in terms of the primary study endpoints which was the cumulative incidence of major adverse cardiac event (MACE) composed of cardiac death, target vessel myocardial infarction (TV-MI), and clinically-driven target lesion revascularization (CD-TLR). Results Of 175 patients, SED detected by OCT was observed in 32 patients, while 143 patients did not show SED. In the crude population, the SED group showed a significantly higher incidence of CD-TLR, definite stent thrombosis, TV-MI and cardiac death relative to the non-SED group. After adjustment by an inverse probability weighted methods, the SED group showed a significantly higher incidence of MACE compared with the non-SED group (hazard ratio 3.43, 95% confidence interval 1.09–10.81, p = 0.035). Fibrocalcific or lipidic plaques, greater lumen eccentricity, and stent-oversizing were the predictors of SED. Conclusions SED detected by OCT after the current-generation DES implantation led to unfavorable outcomes. Aggressive post-dilatation around the stent edge might worse clinical outcomes due to SED, although achievement of optimal stent expansion is strongly encouraged to improve clinical outcomes.

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