Coronary interventions - Mini focus on optical coherence tomography

Identification of the type of stent with three-dimensional optical coherence tomography: the SPQR study

EuroIntervention 2021;17:e140-e148. DOI: 10.4244/EIJ-D-20-00598

Carlos Cortes
Carlos Cortes1,2, MD, PhD; Miao Chu3,4, MS; Michele Schincariol5, MD; Miguel Ángel Martínez-Hervás Alonso3, MD; Bernd Reisbeck3, MD; Ruiyan Zhang6,7, MD, PhD; Yoshinobu Murasato8, MD, PhD; Shao-Liang Chen9, MD, PhD; Francesco Lavarra10, MD; Shengxian Tu4, PhD; Sigmund Silber11, MD, FESC, FACC; Juan Luis Gutiérrez-Chico1,3,12, MD, PhD, FESC, FACC
1. Klinikum Frankfurt (Oder), Frankfurt, Germany; 2. San Pedro Hospital, Logroño, Spain; 3. Cardiology Department, Campo de Gibraltar Health Trust, Algeciras, Spain; 4. Med-X Research Institute, School of Biomedical Engineering, Shanghai Jiao Tong University, Shanghai, China; 5. Klinikum Fürth, Fürth, Germany; 6. Ruijin Hospital, Shanghai, China; 7. Medical University, Shanghai Jiao Tong University, Shanghai, China; 8. Kyushu Medical Center, Fukuoka, Japan; 9. Nanjing First Hospital, Nanjing, China; 10. Jilin Heart Hospital, Changchun, China; 11. Cardiology Practice, Munich, Germany; 12. DRK Klinikum Westend, Berlin, Germany

Background: The ability of optical coherence tomography (OCT) to identify specific types of stent has never been systematically studied.

Aims: The aim of this study was to test the accuracy of OCT imaging to identify patterns of stent platform and subsequently identify the type of stent implanted.

Methods: Consecutive patients from six international centres were retrospectively screened, searching for OCT studies with metallic stents or scaffolds. The sample was analysed by two blinded operators, applying a dedicated protocol in four steps to identify the type of stent: 1) 3D and automatic strut detection (ASD), 2) 3D tissue view, 3) longitudinal view with ASD, 4) mode “stent only” and ASD.

Results: A series of 212 patients underwent OCT in the study centres, finding 294 metallic stents or scaffolds in 146 patients. The protocol correctly identified 285 stents (96.9%, kappa 0.965), with excellent interobserver agreement (kappa 0.988). The performance tended to be better in recently implanted stents (kappa 0.993) than in stents implanted ≥3 months before (kappa 0.915), and in pullback speed 18 mm/s as compared with 36 mm/s (kappa 0.969 vs 0.940, respectively).

Conclusions: The type of stent platform can be accurately identified in OCT by trained analysts following a dedicated protocol, combining 3D-OCT, ASD and longitudinal view. This might be clinically helpful in scenarios of device failure and for the quantification of apposition. The blinding of analysts in OCT studies should be revisited.

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bare metal stentbioresorbable scaffoldsdrug-eluting stentoptical coherence tomography
Coronary interventionsStents and scaffolds
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