Aims To assess the fate of incomplete stent apposition (ISA) after deployment of sirolimus-eluting stents (SESs).Methods and resultsThirty-two patients having intravascular ultrasound (IVUS)-guided PCI with SESs underwent assessment of stent deployment with quantitative coronary angiography, IVUS, and optical coherence tomography (OCT) pre-procedure, post-procedure, and at 10 months follow-up. Incomplete stent apposition was defined as separation of a stent strut from the inner vessel wall by >160 m. At follow-up, 4.67 of struts with ISA at deployment failed to heal and 7.59 which were well apposed did not develop neointimal hyperplasia even after 10 months. Lesion remodelling was responsible for the development of late ISA in only 0.37 of struts. Failure of adequate neointimal hyperplasia was quantitatively the most important mechanism responsible for persistent acute ISA, classified in previous studies, which relied only on follow-up OCT, as late ISA. Thrombus was visualized in 20.6 of struts with ISA at follow-up and in 2.0 of struts with a good apposition (P < 0.001).ConclusionIn patients with SESs, ISA can fail to heal and even complete apposition can be associated with no neointimal hyperplasia. Incomplete stent apposition without neointimal hyperplasia was significantly associated with the presence of OCT-detected thrombus at follow-up, and may constitute a potent substrate for late stent thrombosis

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Keywords Drug-eluting stent, IVUS, Incomplete stent apposition, OCT, Restenosis, Stent thrombosis, acute coronary syndrome, aged, angiocardiography, artery intima proliferation, article, blood vessel wall, clinical article, drug eluting stent, female, follow up, heart infarction, heparin, human, intravascular ultrasound, male, optical coherence tomography, percutaneous coronary intervention, priority journal, rapamycin, stable angina pectoris, stent thrombosis, unstable angina pectoris
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Ozaki, Y., Okumura, M., Ismail, T.F., Naruse, H., Hattori, K., Kan, S., … Serruys, P.W.J.C.. (2010). The fate of incomplete stent apposition with drug-eluting stents: An optical coherence tomography-based natural history study. European Heart Journal, 31(12), 1470–1476. doi:10.1093/eurheartj/ehq066