Abstract 17555: Prognostic Impact of Tissue Protrusion After Stenting in Patients With Acute Coronary Syndrome: an Optical Coherence Tomography Study

Background: Optical Coherence Tomography (OCT) has been studied in stent implantation to assess post-procedural results, with a view to optimizing outcomes but the real clinical impact of OCT-defined abnormalities remains unknown. We investigated the prognostic impact of tissue protrusion between stent struts after stent implantation in patients with non-ST elevation acute coronary syndromes (NSTEACS). Methods: Prospective study of consecutive pts with NSTEACS (≤ 72 h) undergoing PCI for an infarct-related artery presenting a single lesion without diffuse disease on the culprit artery. Patients were treated at the operator’s discretion according to guidelines. OCT was performed after initial angiography and at the end of the angioplasty procedure. Tissue prolapse was defined as projection of tissue (plaque or thrombus) into the lumen between stent struts after implantation. The primary endpoint of procedural complications associated no reflow, and PCI-related myocardial infarction (MI) as defined by a 20% rise in troponin over baseline levels at 24h. Secondary endpoint was the functional result of angioplasty assessed by fractional flow reserve(FFR) measured at the end of the procedure. Results: 43 patients were included, mean age 63±11 years, 90% men. Tissue protrusion was observed in 35 (81%), with this tissue taking up a median 8.85% [IQR 6.2-14.2%] of the intra-luminal area over a median length of 2.8mm [IQR 1.4-5.2]. Presence of tissue protrusion through the struts was not associated with cardiovascular risk factors or pre-treatment with aspirin, thienopyridines, antiGP IIb/IIIa or anticoagulants. Tissue protrusion had no impact on procedural complications or FFR (Table). Conclusion: Tissue protrusion through the struts after stent implantation is common on OCT in NSTEACS patients undergoing angioplasty and stenting. It occludes on average 10% of the intra-stent area, but does not seem to limit flow or impact on post-procedural complications. ![][1] [1]: /embed/graphic-1.gif