Author + information
Stent under expansion and malapposition have been associated with increased rates of stent thrombosis. Adjunctive intravascular imaging can be used to confirm appropriate stent sizing and expansion. Observational studies have linked the use of intravascular ultrasound (IVUS) with lower rates of stent thrombosis. Optical coherence tomography (OCT) is an alternative imaging technology with improved resolution compared with IVUS. There have been no studies to date that assess if OCT-guided PCI is effective in reducing stent thrombosis. The objective of this study is to assess if the use of OCT is associated with lower rates of stent thrombosis compared with IVUS-guided PCI and angiographic guided PCI in a real world setting.
A single center retrospective analysis that included all 2014 PCI's. All cases of stent thrombosis were identified using data from the NY DOH database.
2,684 PCI's were included in this analysis. There was 1 case of stent thrombosis in the OCT arm (n=522, rate 0.19%) compared with 2 cases with IVUS (n=522,rate 0.39%) and 11 cases when no intravascular imaging was used (n=1655, rate 0.66%). The 2 cases of stent thrombosis that occurred with IVUS-guided PCI,included 1 case with IVUS used prior to PCI and 1 case with IVUS used post-PCI. The stent thrombosis case with OCT-guided PCI, involved OCT prior to stent implantation. No cases of stent thrombosis occurred when OCT was used post-PCI. The rate of stent thrombosis was lowest with OCT-guided PCI, but the difference did not reach statistical significance.
With enhanced resolution compared to IVUS, OCT enables optimal stent sizing and confirmation of stent apposition and luminal gain, which could reduce the risk of stent thrombosis. The incidence of stent thrombosis with OCT-guided PCI has not been previously reported or compared to alternative approaches. This single site retrospective study showed a strong trend toward such reduction, but did not achieve statistical significance due to limited sample size and low event rates. Notably, no cases of stent thrombosis were seen when OCT imaging was used post-PCI. Large scale multicenter studies are needed to address this important question.