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In Vivo Comparison Between Optical Coherence Tomography and Intravascular Ultrasound for Detecting Small Degrees of In-Stent Neointima After Stent Implantation

Yoriyasu Suzuki, MD^_*,1, Fumiaki Ikeno, MD^_*,1, Tomomi Koizumi, MD, PhD^_*, Fermin Tio, MD, Alan C. Yeung, MD, FACC^_*, Paul G. Yock, MD, FACC^_*, Peter J. Fitzgerald, MD, PhD, FACC^_*, William F. Fearon, MD, FACC^_*,_*

^_* Division of Cardiovascular Medicine, Stanford University, Stanford, California
University of Texas Health Science Center, San Antonio, Texas.

^_* Reprint requests and correspondence: Dr. William F. Fearon, 300 Pasteur Drive, H3554, Stanford University Medical Center, Stanford, California 94305. (Email: wfearon{at}stanford.edu).

Objectives: The purpose of this study was to evaluate optical coherence tomography (OCT) for detecting small degrees of in-stent neointima (ISN) after stent implantation compared with intravascular ultrasound (IVUS).

Background: The importance of detecting neointimal coverage of stent struts has grown with the appreciation of the increased risk for late stent thrombosis after drug-eluting stent (DES) implantation. Intravascular ultrasound, the current standard for evaluating the status of DES, lacks the resolution to detect the initial neointimal coverage. Optical coherence tomography has greater resolution but has not yet been compared with IVUS in vivo with histological correlation for validation.

Methods: Intravascular ultrasound and OCT were performed with motorized pullback imaging in 6 pigs across 33 stents, 1 month after implantation. Each pig was euthanized, and histological measurements of vessel, stent, and lumen dimensions were performed in 3 sections of each stent. A small degree of ISN was defined as occupying <30% of the stent area measured with histology. The IVUS, OCT, and histological assessment of ISN were compared in matched cross-sections of the stents with a small degree of ISN.

Results: Eleven stents had a small degree of ISN (average ISN area: 1.26 ± 0.46 mm², and percent area obstruction: 21.4 ± 5.2%). Compared with histology, the diagnostic accuracy of OCT (area under the receiver operating characteristic curve [AUC] = 0.967, 95% confidence interval [CI] 0.914 to 1.019) was higher than that of IVUS (AUC = 0.781, 95% CI 0.621 to 0.838).

Conclusions: Optical coherence tomography detects smaller degrees of ISN more accurately than IVUS and might be a useful method for identifying neointimal coverage of stent struts after DES implantation.

Abbreviations and Acronyms   ASA = aspirin   AUC = area under the receiver operating characteristic curve   BMS = bare-metal stent(s)   CI = confidence interval   DES = drug-eluting stent(S)   ISN = in-stent neointima   IVUS = intravascular ultrasound   OCT = optical coherence tomography   ROC = receiver-operating characteristic

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