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Optical coherence tomography endpoints in stent clinical investigations: strut coverage

The International Journal of Cardiovascular Imaging volume 27, pages 271–287 (2011)Cite this article

Abstract

Late stent thrombosis (LST) and very LST (VLST) are infrequent complications after drug-eluting stent (DES) implantation, but they carry a significant risk for patients. Delayed healing, which may be represented by incomplete stent coverage, has been observed in necropsy vessel specimens treated with DES. As a result, in vivo assessment of stent coverage, as well as stent apposition using optical coherence tomography (OCT), have been recently used as surrogate safety endpoints in clinical trials testing DES platforms. By adopting strut coverage assessed by OCT, one can assess the safety profile of the new generation of DES in preregistration studies. This article focuses on stent strut coverage as a central predictor of late DES thrombosis from the histopathological point of view, discusses the limitations of the current imaging modalities and presents the technical characteristics of OCT for the detection of neointimal coverage after stent implantation. We also review the preclinical and clinical investigations using this novel imaging modality.

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Abbreviations

OCT:

Optical coherence tomography

DES:

Drug-eluting stent

IVUS:

Intravascular ultrasound

SES:

Sirolimus-eluting stent

PES:

Paclitaxel-eluting stent

ZES:

Zotarolimus-eluting stent

UA:

unstable angina

SA:

Stable angina

CTO:

Chronic total occlusion

MACE:

Major cardiovascular event

MI:

Myocardial infarction

AMI:

Acute myocardial infarction

LST:

Late stent thrombosis

OLP:

Overlap

TLR:

Target lesion revascularization

AUC:

Area under the receiver operating characteristic curve

PCI:

Percutaneous coronary intervention

NIH:

Neointimal hyperplasia

TD-OCT:

Time-domain optical coherence tomography

FD-OCT:

Fourier-domain optical coherence tomography

TVR:

Target vessel revascularization

NSTACS:

Non-ST elevation acute coronary syndrome

CAD:

Coronary artery disease

CI:

Confidence interval

BMS:

Bare metal stent

PI:

Principle investigator

EES:

Everolimus-eluting stent

BAS:

Bio-active stent

DEB:

Drug-eluting balloon

BES:

Biolimus-eluting stent

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Affiliations

  1. Cardiovascular Research Core Laboratory, University Hospitals Case Medical Center, Cleveland, OH, USA

    Satoko Tahara, Daniel Chamié, Motaz Baibars, Chadi Alraies & Marco Costa

  2. Harrington McLaughlin Heart and Vascular Institute, University Hospitals Case Medical Center, 11100 Euclid Avenue, Cleveland, OH, 44106-5038, USA

    Marco Costa

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  1. Satoko Tahara
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  2. Daniel Chamié
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  3. Motaz Baibars
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Correspondence to Marco Costa.

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Tahara, S., Chamié, D., Baibars, M. et al. Optical coherence tomography endpoints in stent clinical investigations: strut coverage. Int J Cardiovasc Imaging 27, 271–287 (2011). https://doi.org/10.1007/s10554-011-9796-3

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Keywords

  • Strut coverage
  • Optical coherence tomography
  • Drug-eluting stent