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OCT Assessment of Late Stent Malapposition after DES

OCT Assessment of Late Stent Malapposition after DES. Department of Cardiology The 2 nd affiliated hospital of HMU Jingbo Hou. Late stent malapposition -- What is it?. Certain distance between vascular wall and at least one stent strut. 支架贴壁不良是指至少一个以上支架小梁与血管壁之间存在一定的空隙（距离）； SM include

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OCT Assessment of Late Stent Malapposition after DES

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  1. OCT Assessment of Late Stent Malapposition after DES Department of Cardiology The 2nd affiliated hospital of HMU Jingbo Hou

  2. Late stent malapposition-- What is it? • Certain distance between vascular wall and at least one stent strut. • 支架贴壁不良是指至少一个以上支架小梁与血管壁之间存在一定的空隙（距离）； • SM include • instant stent malapposition • late stent malapposition： • continuous malapposition after stent • implantation. • Acquired stent malapposition.

  3. Acquired LSM Follow-up Baseline No remodeling Positive remodeling * Study by Dr. Abizaid, presented at TCT 2005.

  4. Mechanism for LSM • Vascular wall positive remodelling • Absorption of thrombus or plaque component (in ACS) • Chronic retraction of stent • Unclear for exact pathologic mechanism • Delayed healing • Chronic inflammation • Hypersensitive reaction

  5. Stent strut neointimal coverage J Am Coll Cardiol Img, 2010; 3:76-84

  6. Malapposition Which is better?

  7. Long-term follow-up of LSM

  8. Frequency of ISA ---in BMS and DES Trial SIRIUS IVUS TAXUS II IVUS Ako J, et al. JACC. 2005; 46(6):1002-1005. Tanabe K, et al. Circulation. 2005; 111(7):900-905.

  9. OCT assessment of LSM • Late stent malapposition is defined when the distance between its inner surface reflection and the vessel wall is more than strut thickness plus polymer thickness plus OCT resolution.

  10. OCT assessment of LSM Measurement of MSA and MSD. Double-headed red arrow is MSD. Dotted area is MSA.

  11. LSM in our center • LSM in 126 DES stents in 68 patients at least 1 year after implantation were evaluated by OCT in our department； • MSD, MSA, RLA and RSA were examined by OCT.

  12. Clinical data

  13. Quantitative analysis

  14. Late stent thrombosis—DES: Factors to consider Discontinuation of antiplatelet therapy Late incompleteapposition Late stentthrombosis Delayedendothelialization Polymer hypersensitivity/ inflammation

  15. Clinical information • Male，43-year-old； • 2008-4-18: Selective PCIfor subacute anterior MI，2 DES stents were implanted along LAD； • Long smoking and drinking history. • No hypertension and diabetic history.

  16. Clinical information • 2009-7-30： After stopping using of clopidogrel for 2 months, the patient had acute anterior MI again. Thrombolytic therapy was given to him in local hospital. • 2009-8-12：CAG.

  17. 2008-4-18

  18. 2008-4-18

  19. 2008-4-18 2009-8-18

  20. 2008-4-18 2009-8-18 2009-8-18

  21. Possible reason for late thrombus and recurrent MI • Comparison of CAG of two times of PCI, we found obvious coronary positive remodel. • The change of vascular wall induce late stent malapposition. • Late stent malapposition and stop using of dual antiplatelet therapy were probable reasons for very late stent thrombosis.

  22. What can we get from this case? • How to prevent late stent malapposition？ • Choose suitable type of stent in ACS (BMS or others). • New type stents without polymer or biodegradable polymer to induce reendothelization. • Drug therapy to prevent vascular wall positve remodelling??

  23. Treatment to LSM…… • Prolonged dual antiplatelet treatment. How long?? • Implantation for another stent. BMS or covered stent?

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