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

Complications du stenting en OCT Christophe Caussin; Nicolas AMABILE IMM Paris

Conflits d’intérêts • Programme d ’ enseignement / consultant ABBOTT

ESC Recommendations 2018

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

Thrombose de stent

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

Initial Coronary Angiography

OCT J3

Mécanisme thrombose de stent: Malaposition

Mécanisme thrombose de stent: Rupture Néo-athérome Thrombus sur NIH

Mécanisme thrombose de stent: Mailles non recouvertes

Mécanisme thrombose de stent: Evagination tissulaire

Mécanisme thrombose de stent: • Dissection de bords Thrombus ou zones non couvertes

Mechanisms of stent thrombosis according to clinical presentation Global Acute+ Subacute ST Late+ Very Late ST p (n=120) (n=23) (n=97) Malapposition (%) 34 48 32 0.12 Ruptured NA (%) 23 0 28 0.004 Underexpansion (%) 11 26 7 0.02 Coronary Evagination (%) 8 0 10 0.11 ER disease progression (%) 8 4 8 0.45 Isolated uncovered struts (%) 8 0 10 0.11 Neointimal hyperplasia (%) 4 0 5 0.34 Edge dissection (%) 1 4 0 0.19 No cause identified (%) 3 18 0 0.001

Definite Stent Thrombosis Culprit lesion deocclusion (Deferred) OCT analysis Ruptured NA Severe underexpansion Isolated uncovered struts Neointimal hyperplasia Malapposition No underlying Edge disease progression (Coronary evagination) mechanical cause Edge dissection STENT -DEB POBA Medical therapy

Iatrogenic dissection

Barber-Chamoux N et al, Cardiovascular Revascularisation Medicine 2016

Stent deformation

Stent longitudinal compression

Positionnement du guide

Complications of IC imaging • Rotterdam cohort retrospective analysis • N=1142 OCT Pts / N=2476 IVUS pts • 5 April 2008 to December 2013 OCT cohort IVUS cohort p 4 (n=1142) (n=2476) Transient ST-elevation 3 (0.26) 2 (0.08) 0.2 3 Bradycardia 2 (0.18) 1 (0.04) 0.2 Coronary spasm 1 (0.09) 1 (0.04) 0.6 2 P=0.6 Thrombus formation 1 (0.09) 4 (0.16) 0.6 0.61% 1 Dissection 0 (0.00) 3 (0.12) 0.2 0.53% 0.48% Stent deformation 0 (0.00) 1 (0.04) 0.5 0 Events after adjudication Major adverse events 0 (0.00) 0 (0.00) NA Overall OCT IVUS van der Sijde JN et al. EHJ – Cardiovascular Imaging (2017) 18, 467 – 74

OCT catheter induced arterial dissection Smith DK et al, Eurointervention 2012

OCT catheter induced arterial dissection Smith DK et al, Eurointervention 2012

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