Cioffi Giacomo Maria, Lamelas Pablo, Shenouda Mariam, Halperin Jamie, Goffredo Francesca, McGrath Brian Patrick, Vega Servin Norman Said, Mehta Shamir R, Jolly Sanjit S, Schwalm J D, Natarajan Madhu K, Valettas Nicholas, Velianou James L, Tsang Michael B, Pinilla-Echeverri Natalia, Sibbald Matthew G, Sheth Tej N
Division of Cardiology, Hamilton General Hospital, Hamilton Health Sciences, McMaster University, Hamilton, ON, Canada.
Department of Cardiology, University and Hospital of Fribourg, Fribourg, Switzerland.
Front Cardiovasc Med. 2025 May 13;12:1565676. doi: 10.3389/fcvm.2025.1565676. eCollection 2025.
Stent failure (SF) is a complication of percutaneous coronary intervention (PCI).
This study aimed to assess the relationship of the optical coherence tomography (OCT) determined cause of SF with time since stent implantation, treatment, and outcome.
This retrospective study included patients who underwent an OCT evaluation for SF from January 2013 to July 2023. In-stent findings were evaluated on OCT including tissue proliferation, tissue type, underexpansion, thrombus, and multiple stent layers. The relationship between time to presentation, treatment, and outcome was assessed.
Of the 309 patients who underwent an OCT-guided PCI for SF, tissue proliferation was present in 228 (74%) and absent in 81 (26%). Among patients with tissue proliferation, OCT commonly showed lipidic neointima ( = 122, 54%), thrombus ( = 81, 36%), and underexpansion ( = 71, 31%). In patients without tissue proliferation, OCT commonly identified underexpansion ( = 58, 72%), thrombus ( = 55, 68%), and uncovered struts ( = 37, 46%). The mean time to SF was 6.89 ± 5.88 years with tissue proliferation and 2.98 ± 3.75 years without ( < 0.001). Patients with tissue proliferation were more likely to be treated with repeat stenting (78% vs. 60%, < 0.001). Lipidic neointimal tissue and >1 layer of stent were predictors of target SF recurrence during a median 3 years of follow-up.
In a large series of OCT-guided treatments of SF, tissue proliferation was more common, occurred later after stent implantation, and was more likely to be treated with repeat stenting than no-tissue proliferation. Lipidic neointimal tissue and >1 layer of stent were significant predictors of target SF during follow-up.
支架失败（SF）是经皮冠状动脉介入治疗（PCI）的一种并发症。
本研究旨在评估光学相干断层扫描（OCT）确定的SF原因与支架植入后的时间、治疗及结果之间的关系。
这项回顾性研究纳入了2013年1月至2023年7月因SF接受OCT评估的患者。在OCT上评估支架内的表现，包括组织增生、组织类型、扩张不全、血栓形成和多层支架。评估出现症状的时间、治疗和结果之间的关系。
在309例接受OCT引导下SF的PCI患者中，228例（74%）存在组织增生，81例（26%）不存在组织增生。在有组织增生的患者中，OCT常见表现为脂质新生内膜（n = 122，54%）、血栓形成（n = 81，36%）和扩张不全（n = 71，31%）。在无组织增生的患者中，OCT常见表现为扩张不全（n = 58，72%）、血栓形成（n = 55，68%）和支架暴露（n = 37，46%）。有组织增生的患者发生SF的平均时间为6.89±5.88年，无组织增生的患者为2.98±3.75年（P < 0.001）。有组织增生的患者更有可能接受再次支架置入治疗（78%对60%，P < 0.001）。在中位3年的随访期间，脂质新生内膜组织和>1层支架是目标SF复发的预测因素。
在一系列大型OCT引导下的SF治疗中，组织增生更为常见，发生在支架植入后较晚时间，且与无组织增生相比更有可能接受再次支架置入治疗。脂质新生内膜组织和>1层支架是随访期间目标SF的重要预测因素。
