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New Stents, New Procedures, and Intraprocedural Challenges

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

Abstract

Bioresorbable vascular scaffolds (BRSs) have recently reenergized the field of coronary intervention; they support transient drug delivery and vessel patency and then gradually tend to complete resorption. OCT has played a major role in the development of BRS technology by providing more precise and detailed morphologic information (compared to IVUS) as a result of its higher resolution. While the clinical outcome data from the landmark BRS trials are promising, there is a paucity of data on BRS implantation in unselected patient population in “real world” clinical practice, including in-stent restenosis, bifurcation, and severely calcified lesions. Abnormal coronary dilatation at the site of DES implantation demonstrating contrast staining outside the stent struts, peri-stent contrast staining (PSS), have been shown to be associated with target-lesion revascularization and very late stent thrombosis. OCT can differentiate between two main underlying causes of PSS, incomplete stent apposition and multiple interstrut hollows or cavities between well apposed stent struts. Intraluminal filling defects are occasionally observed on coronary angiography, and thrombosis has often been used as a default diagnosis; however, there are many different causes responsible for the phenomenon including calcification, dissection, plaque rupture, and artifacts. OCT allows accurate characterization angiographic filling defects and provides important information for treatment optimization.

Keywords

Drug-eluting stents Bare metal stents Stent thrombosis Bioresorbable vascular scaffolds Peri-stent contrast staining Intraluminal filling defects Thrombosis Calcified lesion Dissection In-stent restenosis Lipid-rich plaque Thin fibrous cap Stent edge dissection Healed plaque rupture 

Supplementary material

Video 5.1

OCT pullback after rotational atherectomy for heavily calcified LAD lesions (Case 1, Fig. 5.1, B1–B4, C) (AVI 16764 kb)

Video 5.2

OCT pullback performed after implantation of two bioresorbable vascular scaffolds (Case 1, Fig. 5.2, B1–B5, C) (AVI 23382 kb)

Video 5.3

OCT pullback performed after chronic total occlusion was crossed and orbital atherectomy performed for the calcified lesion (Case 2, Fig. 5.3, B1–B7, C) (AVI 21623 kb)

Video 5.4

OCT pullback of the chronic total occlusion after bioresorbable vascular scaffold implantation (Case 2, Fig. 5.4, B1–B5, C) (AVI 22870 kb)

Video 5.5

OCT pullback for the case of late stent malapposition with total occlusion of the stent (Explaining the unexplainable) (Case 3, Fig. 5.5, B1–B8, C) (AVI 20794 kb)

Video 5.6

OCT pullback before stenting for an intermediate stenosis with intraluminal filling defect in the proximal LAD, Clarifying the halos (Case 4, Fig. 5.6, B1–B4, C1, C2) (AVI 19666 kb)

Video 5.7

Post-stent OCT for the “Clarifying the halos” case (Case 4, Fig. 5.7, B1, B2, C1, C2) (AVI 19438 kb)

Video 5.8

OCT pullback before stenting mid LAD stenosis (Case 5, Fig. 5.8, B1–B5, C) (AVI 22121 kb)

Video 5.9

OCT performed after mid LAD stenting showed new thrombus in the proximal LAD (Case 5, Fig. 5.9, B1–B5, C) (AVI 22216 kb)

Video 5.10

Final post-PCI OCT pullback after proximal LAD noncompliant balloon post-dilatation (Case 5, Fig. 5.10, B1–B5, C) (AVI 22088 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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