Prolapse Following Carotid Artery Stenting by OCT Bernhard Reimers, - - PowerPoint PPT Presentation

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Characterization of Plaque Prolapse Following Carotid Artery Stenting by OCT Bernhard Reimers, MD Mirano, Italy Disclosure Statement of Financial Interest I, Bernhard Reimers DO NOT have a financial interest/arrangement or affiliation with

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Characterization of Plaque Prolapse Following Carotid Artery Stenting by OCT

Bernhard Reimers, MD Mirano, Italy

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Disclosure Statement of Financial Interest I, Bernhard Reimers DO NOT have a financial interest/arrangement or affiliation with one or more organizations that could be perceived as a real or apparent conflict of interest in the context of the subject of this presentation.

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Definition

Plaque prolapse is defined as tissue extrusion through the stent struts post- procedure. Brack MJ, et al. Int J Cardiol. 1994;44(1):93- 95

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Heart: From enzyme rise to heart attack Brain: From ischemic lesions to stroke Possible distal embolization

Consequences of plaque prolapse

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Relation between plaque components and plaque prolapse after DES implantation: virtual histology –intravascular ultrasound Hong YJ et al. Circ J 2010;74:1142

Necrotic core and fibrotic components were associated with development of PP; and both components in prolapsed plaque were associated with cardiac enzyme elevation after DES implantation.

BMJ Case Reports 2009; Tsui, Lau

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SPACE

CEA & CAS have additional complications within 30 days

Lancet 2006

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DW MRI before and 5 days after CAS DESERVE Study

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Cause of plaque prolapse

Cheese grater effect of stents:

during deployment,
during postdilatation (most TCD hits),
during 30-days post procedure

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Cheese grating is not always good

Increased plaque prolapse from coronary experience:

thrombotic lesion
lipid core
thin cap over necrotic core

Hung et al; Circ 2010 Differences between soft and hard cheeses plaques

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Detection of plaque prolapse

Angiography IVUS OCT AHA Journals; BMJ; J Intevent Cardiol In coronary arteries

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Precise NexStent Xact Acculink Ø = 0.107 mm Ø = 0.118 mm

Ø = 0.128 mm Ø = 0.173 mm

Closed-cell stents Open-cell stents

The concept of plaque scaffolding of stents

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Emboli Protection Strategies and OCT acquisition

Non Occlusive Technique

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Emboli Protection Strategies and OCT acquisition

Occlusive Technique

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1 Positioning of OCT catheter distal to stent

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2 Careful hand injection of 20cc dye (Ultravist 320) 3 When images ok: pull-back of OCT system

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4 Hand re-aspiration of dye

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Carotid OCT

After stent in stent with Acculink 6-8 x 40 mm and postdilatation with 5.5 x 20 a 12 atm balloon

Post stent OCT

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Small ulcers (no clinical determinant of complictions)

Carotid OCT

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Open cell struts Closed cell struts

Carotid OCT

Open cell stent Closed cell stent

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Plaque rupture

Carotid OCT

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Flow artefact

Carotid OCT

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Carotid OCT

Plaque prolapse: Possible determinants of late complications

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Carotid OCT before CAS

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Lesion after stenting

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Final result after post-dilatation

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Conclusions (1)

OCT after carotid stenting appears feasible and safe. Using the occlusive technique, better quality images were

btained with the advantage not to increase the contrast load

Carotid OCT allows collection of important information regarding the stent and plaque behaviour not seen with standard angiography Compared to IVUS less penetration (for plaque characterization), better surface images (for stent evaluation)

Reimers et al.; EuroIntervention 2011

Conclusions

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Interv. Cardiol 2010;2:535

Prolapse Malapposition Prolapse Prolapse Dissection Coronary OCT