Imaging to optimise stent deployment

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Advantages and disadvantages of different intracoronary imaging and haemodynamic modalities[1].

Fractional flow reserve (FFR), intravascular ultrasound (IVUS) and optical coherence tomography (OCT) have different roles in assessing different coronary segments.

Definitions[2]

  • Malapposition: occurs when a stent (or portion of a stent) does not make contact with the vessel wall
  • Under expansion: occurs when the stent (or a portion of the stent) is not at nominal diameter
  • Under deployment is an imprecise term and should not be used.
Some mechanical causes of stent thrombosis identified on OCT.[3]

Causes of stent thrombosis[4]

  • In cases of stent thrombosis, intravascular imaging with IVUS or OCT should be performed after initial aspiration or PCI to restore flow.
  • Possible mechanical causes of stent thrombosis include:
    • Malapposition
    • Underexpansion
    • Protrusion
    • Edge dissection
  • Factors associated with stent thrombosis in the HORIZONS-AMI Trial[5]:
    • Under expansion (CSA < 5 mm2)
    • Protrusion
    • Dissection
    • Malapposition was not associated with stent thrombosis.
  • IVUS guided stent placement compared to no IVUS is associated with less stent thrombosis[6]

References

  1. Mayo Clinic Interventional Cardiology Review Board 2017.
  2. JACC 2014;64:207.
  3. JACC 2014;64:207.
  4. Circ Cardiovascular Interv 2011;4:239.
  5. Circ Cardiovasc Interv 2011;4:239.
  6. Roy Our Heart J 2008;29:1851.