The Official Journal of EuroPCR and the European Association of Percutaneous Coronary Interventions (EAPCI)

In-Stent Restenosis Lesion Morphology Related to Repeat Stenting Underexpansion as Evaluated by Optical Coherence Tomography

DOI: 10.4244/EIJ-D-18-01191

1. Clinical Trials Center, Cardiovascular Research Foundation, New York, NY, USA
2. Clinical Trials Center, Cardiovascular Research Foundation, New York, NY, USA
3. Clinical Trials Center, Cardiovascular Research Foundation, New York, NY, USA
4. Clinical Trials Center, Cardiovascular Research Foundation, New York, NY, USA
5. Clinical Trials Center, Cardiovascular Research Foundation, New York, NY, USA
6. Clinical Trials Center, Cardiovascular Research Foundation, New York, NY, USA
7. Clinical Trials Center, Cardiovascular Research Foundation, New York, NY, USA
8. Clinical Trials Center, Cardiovascular Research Foundation, New York, NY, USA
9. NewYork-Presbyterian Hospital/Columbia University Medical Center, New York, NY, USA
10. Clinical Trials Center, Cardiovascular Research Foundation, New York, NY, USA
11. Clinical Trials Center, Cardiovascular Research Foundation, New York, NY, USA
12. St. Francis Hospital, Roslyn, NY, USA
13. Clinical Trials Center, Cardiovascular Research Foundation, New York, NY, USA, United States
14. Abbott Vascular, Santa Clara, CA, USA
15. St. Francis Hospital, Roslyn, NY, USA
Disclaimer:

As a public service to our readership, this article - peer reviewed by the Editors of EuroIntervention - has been published immediately upon acceptance as it was received. The content of this article is the sole responsibility of the authors, and not that of the journal or its publishers.

To read the full content of this article, please log in to download the PDF.

Aims: To use optical coherence tomography (OCT) to predict newly implanted stent expansion for treatment of in-stent restenosis (ISR).

Methods and results: With OCT-guidance, 143 ISR lesions were treated with a new stent. Stent underexpansion was defined as minimum stent area (MSA) <4.5mm 2 and MSA/average of reference lumen area <70%. New stent underexpansion was found in 33 lesions (23%), had a smaller old stent MSA (4.13 [3.32-4.62] versus 5.18 [4.01-6.38] mm 2 , p=0.001), and had a higher prevalence of multiple old stent layers (51.5% versus 10.9%, p<0.001) and neointimal or peri-stent calcium (69.7% versus 37.3%, p=0.001) compared to those without new stent underexpansion. Old stent underexpansion, multiple layers of old stent, maximum calcium angle >180°, and maximum calcium thickness >0.5mm were independently associated with new stent underexpansion. Patients with new stent underexpansion had a higher prevalence of major adverse cardiac events (35.5% vs 14.3%, p=0.009) mainly driven by a higher rate of myocardial infarction and target vessel revascularization at 2 years.

Conclusions: When re-stenting an ISR lesion, old stent underexpansion, the amount of neointimal or peri-stent calcium, and multiple old stent strut layers are important determinants of new stent underexpansion that is then associated with adverse long-term outcomes.

Sign in to read and download the full article

Forgot your password?
No account yet? Sign up for free!
Create my pcr account

Join us for free and access thousands of articles from EuroIntervention, as well as presentations, videos, cases from PCRonline.com

Read next article

Dual antiplatelet therapy after percutaneous coronary intervention: entering the final chapter?