Optical Coherence Tomography Findings in Patients With Stent Thrombosis

Abstract

Introduction and objectives: Stent thrombosis (ST) is a rare but potentially serious complication. Optical coherence tomography (OCT) provides high-resolution images and additional information to angiography in the study of this event.

Methods: Prospective study of patients with ST undergoing reintervention with OCT imaging.

Results: The study included a total of 40 consecutive patients with ST. Mean age was 69 ± 13 years and 83% were male. Early ST (≤ 30 days) was observed in 16 patients and late ST (> 30 days) in 24 patients. Stent thrombosis occurred in 17 bare-metal stents and 23 drug-eluting stents. In 34 patients (85%), adequate OCT images were obtained at the time of the ST. The predominant mechanism in early ST was stent malapposition (39%). In late ST, high frequencies of uncovered (46%) and malapposed struts (17%) were observed, especially in patients with drug-eluting stents. Furthermore, the presence of neoatherosclerosis was very high (67%) in patients with late ST. After intervention, improvements were observed in malapposition length and the amount of residual thrombus.

Conclusions: OCT allows identification of the underlying mechanisms potentially involved in ST. This imaging modality is helpful in guiding reintervention in these patients, which improves the area and length of malapposition, as well as the maximal residual thrombus area.

Keywords: Angiografía; Angiography; Coronary intervention; Intervencionismo coronario; Optical coherence tomography; Reestenosis del stent; Stent restenosis; Stent thrombosis; Tomografía de coherencia óptica; Trombosis del stent.