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Post-Stent Evaluation, Stent Thrombosis, and In-Stent Restenosis

  • Annapoorna Kini
  • Jagat Narula
  • Yuliya Vengrenyuk
  • Samin Sharma
Chapter

Abstract

Optimization of stent deployment during percutaneous coronary interventions (PCI) is one of the most important factors in achieving favorable immediate and long-term outcomes. In addition to stent underexpansion, OCT can detect several features of suboptimal stent deployment including edge dissection, malapposition, intrastent plaque protrusion, and reference lumen area narrowing. Stent thrombosis (ST) is an infrequent but highly morbid complication of PCI with mortality rates of 10–20 % during the first year. OCT represents a unique tool for ST diagnosis and evaluation; it can help understand whether a procedure-related mechanism is involved in ST and select the most appropriate treatment strategy. Although introduction of DES dramatically reduced the occurrence of aggressive neointimal proliferation, treatment of in-stent restenosis (ISR) after stent implantation remains a major clinical problem. Intrastent plaque morphology assessment with OCT imaging can positively impact outcomes by optimizing PCI in complex lesions.

Keywords

Stent expansion Strut malapposition Tissue protrusion In-stent dissection Rotational atherectomy Orbital atherectomy Cutting balloon angioplasty Bifurcation lesion In-stent restenosis Acute and subacute stent thrombosis 

Supplementary material

Video 4.1

OCT pullback of RCA before percutaneous coronary intervention (Case 1, Fig. 4.1B1–B5, C1, C2) (AVI 21118 kb)

Video 4.2

OCT pullback performed after stenting (Case 1, Fig. 4.2B1–B3, C) (AVI 21153 kb)

Video 4.3

Final post-PCI OCT image performed after postdilatation (Case1, Fig. 4.3B1–B2, C) (AVI 21134 kb)

Video 4.4

OCT pullback of RCA before intervention (Case 2, Fig. 4.4, frames B1–B2, C) (AVI 21173 kb)

Video 4.5

OCT pullback after stent implantation (Case 2, Fig. 4.5B1–B5, C) (AVI 21151 kb)

Video 4.6

Final OCT pullback of RCA after postdilatation (Case 2, Fig. 4.6, frames B1–B4, C) (AVI 21169 kb)

Video 4.7

OCT images of a heavily calcified bifurcation lesion before PCI (Case 3, Fig. 4.7B1–B4, C) (AVI 21172 kb)

Video 4.8

OCT pullback after rotational atherectomy and stenting (Case 3, Fig. 4.8, B1–B2, C) (AVI 21127 kb)

Video 4.9

OCT pullback performed after postdilatation (Case 3, Fig. 4.9, B1–B2, C) (AVI 21170 kb)

Video 4.10

OCT images of acute stent thrombosis in the LCX (Case 4, Fig. 4.10B1–B3, C) (AVI 19288 kb)

Video 4.11

OCT images of subacute stent thrombosis in the RCA (Case 5, Fig. 4.11B1–B8, C) (AVI 21144 kb)

Video 4.12

Post-PCI OCT pullback after stent dilatation with a noncompliant balloon (Case 5, Fig. 4.12B1–B5, C) (AVI 21110 kb)

Video 4.13

OCT images of subacute stent thrombosis in the LAD (Case 6, Fig. 4.13B1–B5, C) (AVI 21603 kb)

Video 4.14

Final post-PCI OCT pullback after thrombectomy and cutting balloon angioplasty (Case 6, Fig. 4.14B1–B5, C) (AVI 21582 kb)

Video 4.15

Pre-PCI OCT images of a calcified ISR bifurcation lesion (Case 8, Fig. 4.16B1–B6, C1, C2) (AVI 21123 kb)

Video 4.16

OCT pullback of a calcified LAD lesion before orbital atherectomy (Case 9, Fig. 4.17B1–B6, C1) (AVI 25819 kb)

Video 4.17

OCT pullback of a calcified LAD lesion after orbital atherectomy (Case 9, Fig. 4.17B7–B12, C2) (AVI 25780 kb)

Video 4.18

OCT images of an ISR lesion after cutting balloon angioplasty (Case 10, Fig. 4.18B1–B4, C) (AVI 19142 kb)

Video 4.19

Post-PCI OCT pullback of stented RCA (Case 10, Fig. 4.19B1–B5, C) (AVI 26260 kb)

Video 4.20

OCT images of in-stent restenosis with chronic total occlusion of the LCX (Case 11, Fig. 4.20B1–B4, C) (AVI 25607 kb)

Video 4.21

Post-stent OCT of the LCX (Case 11, Fig. 4.21B1–B5, C) (AVI 25813 kb)

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Copyright information

© Springer International Publishing AG 2018

Authors and Affiliations

  • Annapoorna Kini
    • 1
  • Jagat Narula
    • 2
  • Yuliya Vengrenyuk
    • 3
  • Samin Sharma
    • 4
  1. 1.Director, Cardiac Catheterization Laboratory, Director, Structural Heart Intervention Program, Director, Interventional Cardiology Fellowship Program, Zena and Michael A. Wiener Professor of MedicineIcahn School of Medicine at Mount Sinai, Mount Sinai HospitalNew YorkUSA
  2. 2.Director, Intravascular Imaging Core Laboratory, Instructor, Department of MedicineIcahn School of Medicine at Mount Sinai, Mount Sinai HospitalNew YorkUSA
  3. 3.Philip J. and Harriet L. Goodhart Chair in Cardiology, Chief of Cardiology, Mount Sinai St. Luke’s Hospital, Professor of Medicine and Radiology, Associate Dean, Arnhold Institute for Global HealthIcahn School of Medicine at Mount Sinai, Mount Sinai HospitalNew YorkUSA
  4. 4.Director, Clinical and Interventional Cardiology, President, Mount Sinai Heart Network, Dean, International Clinical Affiliations, Anandi Lal Sharma Professor of MedicineIcahn School of Medicine at Mount Sinai, Mount Sinai HospitalNew YorkUSA

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