en OCT Christophe Caussin; Nicolas AMABILE IMM Paris Conflits - - PowerPoint PPT Presentation

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May 18, 2023 588 likes •918 views

Complications du stenting en OCT Christophe Caussin; Nicolas AMABILE IMM Paris Conflits dintrts Programme d enseignement / consultant ABBOTT ESC Recommendations 2018 Thrombose de stent Dissection iatrogne Deformation &

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Complications du stenting en OCT

Christophe Caussin; Nicolas AMABILE IMM Paris

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Conflits d’intérêts

  • Programme d’enseignement / consultant ABBOTT
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ESC Recommendations 2018

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Thrombose de stent Dissection iatrogène Deformation & compression Stent Positionnement du guide Complications de l’imagerie

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Thrombose de stent

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Mme M 57 ans

  • ATCD
  • Stent Cx Mg DES il y a 5 ans et
  • Stent in stent EES il y a 14mois pour resténose
  • Admise pour STEMI latéral
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Initial Coronary Angiography

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OCT J3

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Mécanisme thrombose de stent: Malaposition

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Mécanisme thrombose de stent:

Rupture Néo-athérome Thrombus sur NIH

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Mécanisme thrombose de stent: Mailles non recouvertes

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Mécanisme thrombose de stent: Evagination tissulaire

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Mécanisme thrombose de stent:

  • Dissection de bords

Thrombus ou zones non couvertes

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Mechanisms of stent thrombosis according to clinical presentation

Global (n=120) Acute+ Subacute ST (n=23) Late+ Very Late ST (n=97) p Malapposition (%) 34 48 32 0.12 Ruptured NA (%) 23 28 0.004 Underexpansion (%) 11 26 7 0.02 Coronary Evagination (%) 8 10 0.11 ER disease progression (%) 8 4 8 0.45 Isolated uncovered struts (%) 8 10 0.11 Neointimal hyperplasia (%) 4 5 0.34 Edge dissection (%) 1 4 0.19 No cause identified (%) 3 18 0.001

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Definite Stent Thrombosis

Ruptured NA Neointimal hyperplasia Edge disease progression Severe underexpansion Malapposition (Coronary evagination) Edge dissection Isolated uncovered struts No underlying mechanical cause

STENT -DEB POBA Medical therapy Culprit lesion deocclusion (Deferred) OCT analysis

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Iatrogenic dissection

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Barber-Chamoux N et al, Cardiovascular Revascularisation Medicine 2016

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Stent deformation

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Stent longitudinal compression

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Positionnement du guide

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Complications of IC imaging

OCT cohort (n=1142) IVUS cohort (n=2476) p Transient ST-elevation 3 (0.26) 2 (0.08) 0.2 Bradycardia 2 (0.18) 1 (0.04) 0.2 Coronary spasm 1 (0.09) 1 (0.04) 0.6 Thrombus formation 1 (0.09) 4 (0.16) 0.6 Dissection 0 (0.00) 3 (0.12) 0.2 Stent deformation 0 (0.00) 1 (0.04) 0.5 Major adverse events 0 (0.00) 0 (0.00) NA 1 2 3 4 5 Events after adjudication

Overall OCT IVUS

0.53% 0.61% 0.48% P=0.6 van der Sijde JN et al. EHJ– Cardiovascular Imaging (2017) 18, 467–74

  • Rotterdam cohort retrospective analysis
  • N=1142 OCT Pts / N=2476 IVUS pts
  • April 2008 to December 2013
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OCT catheter induced arterial dissection

Smith DK et al, Eurointervention 2012

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OCT catheter induced arterial dissection

Smith DK et al, Eurointervention 2012

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IC Imaging & Complications

  • Complications of ICI : extremely rare & easily treatable
  • Complications of ICI : could be prevented by coronary

anatomy analysis & adequate catheter handling

  • ICI is a major tool to identify and guide PCI complications

management