OCT Feasible for Identifying Factors Related to Stent Thrombosis

Optical coherence tomography (OCT) can be used in the acute setting of PCI for patients presenting with stent thrombosis and hemodynamic stability to identify factors related to the complication, according to results of the PRESTIGE OCT study presented at TCT 2015.  

Using data from the larger PRESTIGE Registry, which explores novel predictors and clinical outcomes following stent thrombosis, Giulio Guagliumi, MD, of Ospedale Papa Giovanni XXIII, Bergamo, Italy, and colleagues looked at data on 217 patients who had angiographic confirmation of definite stent thrombosis defined by Academic Research Consortium (ARC) criteria and underwent OCT of the target vessel at 29 centers with OCT capabilities. OCT before intervention was strongly recommended, and OCT immediately after emergent PCI was suggested, according to Guagliumi.

Sixty-two patients had acute or subacute stent thrombosis and 155 had late or very late events. Most patients in each group presented with STEMI (79.0% and 71.7%, respectively). At presentation, “diabetes was highly represented in the group with acute/subacute stent thrombosis… [and] one-third of patients with late/very late stent thrombosis were continuously active smokers,” Guagliumi said.

For qualitative and quantitative OCT analysis, expert readers were blinded to patient characteristics and the timing of stent thrombosis. A second expert group of blinded interventional cardiologists and a pathologist with expertise in OCT were assigned to adjudicate causative imaging factors.

Uncovered struts represented the most frequent dominant imaging findings in patients with acute and subacute stent thrombosis (78.6% and 59.6%, respectively). The second most common finding was malapposed struts in patients with acute stent thrombosis (21.4%) and underexpansion in patients with subacute events (25.5%). Guagliumi reported more heterogeneous dominant imaging findings among patients presenting with late or very late stent
thrombosis (Figure).

Guagliumi pointed out some limitations of the substudy, including the selected patient population; the fact that the temporal distribution of stent thrombosis was inconsistent with prior studies, stemming from the preferential use of OCT in patients with late and very late events; and the possibility that remaining thrombus may have had an impact on measurements and the identification of causative imaging factors.

Disclosures: 

• Guagliumi reports receiving grant/research support from Abbott Vascular, Boston Scientific Corporation and St. Jude Medical and consulting fees/honoraria from Boston Scientific Corporation and St. Jude Medical.