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      Optical Coherence Tomography Findings in Patients With Coronary Stent Thrombosis : A Report of the PRESTIGE Consortium (Prevention of Late Stent Thrombosis by an Interdisciplinary Global European Effort)

      , MD, PhD * , , MD * , , MSc, , MD, , MD, PhD, , MD, , MD, , MD, , MD, , MD, , MD, , MD, PhD, , MD, , PhD, , MD, , MD, PhD, , MD, , MSc, , MD, , MD, PhD, , MD, , MD, , MD, , MD , , MB, BCh, PhD ,
      Lippincott Williams & Wilkins
      atherosclerosis, malapposition, stents, thrombosis, tomography, optical coherence, uncovered struts

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          Stent thrombosis (ST) is a serious complication following coronary stenting. Intravascular optical coherence tomography (OCT) may provide insights into mechanistic processes leading to ST. We performed a prospective, multicenter study to evaluate OCT findings in patients with ST.


          Consecutive patients presenting with ST were prospectively enrolled in a registry by using a centralized telephone registration system. After angiographic confirmation of ST, OCT imaging of the culprit vessel was performed with frequency domain OCT. Clinical data were collected according to a standardized protocol. OCT acquisitions were analyzed at a core laboratory. Dominant and contributing findings were adjudicated by an imaging adjudication committee.


          Two hundred thirty-one patients presenting with ST underwent OCT imaging; 14 (6.1%) had image quality precluding further analysis. Of the remaining patients, 62 (28.6%) and 155 (71.4%) presented with early and late/very late ST, respectively. The underlying stent type was a new-generation drug-eluting stent in 50.3%. Mean reference vessel diameter was 2.9±0.6 mm and mean reference vessel area was 6.8±2.6 mm 2. Stent underexpansion (stent expansion index <0.8) was observed in 44.4% of patients. The predicted average probability (95% confidence interval) that any frame had uncovered (or thrombus-covered) struts was 99.3% (96.1–99.9), 96.6% (92.4–98.5), 34.3% (15.0–60.7), and 9.6% (6.2–14.5) and malapposed struts was 21.8% (8.4–45.6), 8.5% (4.6–15.3), 6.7% (2.5–16.3), and 2.0% (1.2–3.3) for acute, subacute, late, and very late ST, respectively. The most common dominant finding adjudicated for acute ST was uncovered struts (66.7% of cases); for subacute ST, the most common dominant finding was uncovered struts (61.7%) and underexpansion (25.5%); for late ST, the most common dominant finding was uncovered struts (33.3%) and severe restenosis (19.1%); and for very late ST, the most common dominant finding was neoatherosclerosis (31.3%) and uncovered struts (20.2%). In patients presenting very late ST, uncovered stent struts were a common dominant finding in drug-eluting stents, and neoatherosclerosis was a common dominant finding in bare metal stents.


          In patients with ST, uncovered and malapposed struts were frequently observed with the incidence of both decreasing with longer time intervals between stent implantation and presentation. The most frequent dominant observation varied according to time intervals from index stenting: uncovered struts and underexpansion in acute/subacute ST and neoatherosclerosis and uncovered struts in late/very late ST.

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          Most cited references23

          • Record: found
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          Measuring agreement in method comparison studies.

          Agreement between two methods of clinical measurement can be quantified using the differences between observations made using the two methods on the same subjects. The 95% limits of agreement, estimated by mean difference +/- 1.96 standard deviation of the differences, provide an interval within which 95% of differences between measurements by the two methods are expected to lie. We describe how graphical methods can be used to investigate the assumptions of the method and we also give confidence intervals. We extend the basic approach to data where there is a relationship between difference and magnitude, both with a simple logarithmic transformation approach and a new, more general, regression approach. We discuss the importance of the repeatability of each method separately and compare an estimate of this to the limits of agreement. We extend the limits of agreement approach to data with repeated measurements, proposing new estimates for equal numbers of replicates by each method on each subject, for unequal numbers of replicates, and for replicated data collected in pairs, where the underlying value of the quantity being measured is changing. Finally, we describe a nonparametric approach to comparing methods.
            • Record: found
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            Pathological correlates of late drug-eluting stent thrombosis: strut coverage as a marker of endothelialization.

            Late stent thrombosis (LST) after Cypher and Taxus drug-eluting stent placement has emerged as a major concern. Although the clinical predictors of LST have been reported, specific morphological and histological correlates of LST remain unknown. From a registry totaling 81 human autopsies of drug-eluting stents, 46 (62 lesions) had a drug-eluting stent implanted >30 days. We identified 28 lesions with thrombus and compared those with 34 of similar duration without thrombosis using computer-guided morphometric and histological analyses. LST was defined as an acute thrombus within a coronary artery stent in place >30 days. Multiple logistic generalized estimating equations modeling demonstrated that endothelialization was the best predictor of thrombosis. The morphometric parameter that best correlated with endothelialization was the ratio of uncovered to total stent struts per section. A univariable logistic generalized estimating equations model of occurrence of thrombus in a stent section versus ratio of uncovered to total stent struts per section demonstrated a marked increase in risk for LST as the number of uncovered struts increased. The odds ratio for thrombus in a stent with a ratio of uncovered to total stent struts per section >30% is 9.0 (95% CI, 3.5 to 22). The most powerful histological predictor of stent thrombosis was endothelial coverage. The best morphometric predictor of LST was the ratio of uncovered to total stent struts. Heterogeneity of healing is a common finding in drug-eluting stents with evidence of LST and demonstrates the importance of incomplete healing of the stented segment in the pathophysiology of LST.
              • Record: found
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              Expert review document on methodology, terminology, and clinical applications of optical coherence tomography: physical principles, methodology of image acquisition, and clinical application for assessment of coronary arteries and atherosclerosis.

              Optical coherence tomography (OCT) is a novel intravascular imaging modality, based on infrared light emission, that enables a high resolution arterial wall imaging, in the range of 10-20 microns. This feature of OCT allows the visualization of specific components of the atherosclerotic plaques. The aim of the present Expert Review Document is to address the methodology, terminology and clinical applications of OCT for qualitative and quantitative assessment of coronary arteries and atherosclerosis.

                Author and article information

                Lippincott Williams & Wilkins
                12 September 2017
                11 September 2017
                : 136
                : 11
                : 1007-1021
                From Department of Cardiology, University Hospitals Leuven and Department of Cardiovascular Sciences, KU Leuven, Belgium (T.A., D.D.C., W.D.); Deutsches Herzzentrum München, Technische Universität München, Germany (M.J., E.X., T.T., A.K., R.A.B.); Department of Cardiology, St. Antonius Hospital, Nieuwegein, The Netherlands (T.C.G., J.M.t.B.); Department of Cardiovascular Sciences, University of Leicester & Leicester NIHR Cardiovascular Biomedical Research Unit, Glenfield Hospital, United Kingdom (N.M., A.H. Goodall, A.H. Gershlick); Hospital Universitario de La Princesa, Madrid, Spain (F.A., J.C.); Azienda Ospedaliera Papa Giovanni XXIII, Bergamo, Italy (K.K., V.S., G.G.); Département de Cardiologie, AP-HP, DHU FIRE, U-1148 INSERM, Hôpital Bichat, Paris, France (L.J.F.); Universitäts- Herzzentrum Freiburg-Bad Krozingen, Germany (F.-J.N.); Department of Cardiology, Noordwest Ziekenhuisgroep, Alkmaar, The Netherlands (T.H.); Antwerp Cardiovascular Institute, ZNA Middelheim, Belgium (I.B.); Department of Cardiology, ICRC, St. Anne University Hospital, Masaryk University, Brno, Czech Republic (O.H.); Department of Biostatstics (I-BioStat), KU Leuven – University of Leuven & Universiteit Hasselt, Belgium (A.B.); Medizinische Klinik und Poliklinik I, Ludwig-Maximilians-Universität, Munich, Germany (S.M.); and DZHK (German Centre for Cardiovascular Research), partner site Munich Heart Alliance, Germany (S.M., A.K., M.J., R.A.B.).
                Author notes
                Correspondence to: Robert A. Byrne, MBBCh, PhD, Deutsches Herzzentrum München, Klinik an der Technischen Universität München, Lazarettstrasse 36, 80636 Munich, Germany. E-mail byrne@ 123456dhm.mhn.de
                © 2017 The Authors.

                Circulation is published on behalf of the American Heart Association, Inc., by Wolters Kluwer Health, Inc. This is an open access article under the terms of the Creative Commons Attribution Non-Commercial-NoDerivs License, which permits use, distribution, and reproduction in any medium, provided that the original work is properly cited, the use is noncommercial, and no modifications or adaptations are made.

                Original Research Articles
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                atherosclerosis,malapposition,stents,thrombosis,tomography, optical coherence,uncovered struts


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