OCT-based diagnosis, management, and predictors of recurrent stent failure: a cohort study

Giacomo Maria Cioffi^1,2*Pablo Lamelas^3,4Mariam Shenouda¹Jamie Halperin¹Francesca Goffredo⁵Brian Patrick McGrath⁶Norman Said Vega Servin⁶Shamir R Mehta^5,6Sanjit S Jolly^5,6JD Schwalm^5,6Madhu K Natarajan^5,6Nicholas Valettas⁶James L Velianou⁶Michael B Tsang⁶Natalia Pinilla⁶Matthew G Sibbald^1,6Tej N Sheth^6*

• ¹McMaster University, Hamilton, Canada
• ²Université de Fribourg, Fribourg, Fribourg, Switzerland
• ³Department of Health Research Methods, Evidence & Impact, Faculty of Health Sciences, McMaster University, Hamilton, Ontario, Canada
• ⁴Fundacion de la Salud Buenos Aires, Buenos Aires, Buenos Aires, Argentina
• ⁵Population Health Research Institute, Faculty of Health Sciences, McMaster University, Hamilton, Ontario, Canada
• ⁶Hamilton Health Sciences, Hamilton, Ontario, Canada

Objectives: To assess the relationship of the optical coherence tomography (OCT) determined cause of SF with time since stent implantation, treatment, and outcome.Patients undergoing an OCT evaluation for SF from January 2013 to July 2023 were retrospectively included. In-stent findings were evaluated on OCT including presence of tissue proliferation, tissue type, underexpansion, thrombus, and multiple stent layers and the relationship with time to presentation, treatment, and outcome were assessed.Of 309 patients undergoing an OCT-guided PCI for SF, tissue proliferation was present in 228 (74%) and absent in 81 (26%). Among patients with tissue proliferation, OCT commonly showed lipidic neointima (n=122, 54%), thrombus (n=81, 36%), and underexpansion (n=71, 31%).In patients without tissue proliferation, OCT commonly identified underexpansion (n=58, 72%), thrombus (n=55, 68%), and uncovered struts (n=37, 46%). Mean time to SF was 6.89±5.88 years with tissue proliferation and 2.98±3.75 years without (p<0.001). Patients with tissue proliferation were more likely to be treated with repeat stenting (78% vs 60%, p<0.001). Lipidic neointimal tissue and > 1 layer of stent were predictors of target SF recurrence during a median 3 years of follow-up.In a large series of OCT-guided treatment of SF, tissue proliferation was more common, occurred later after stent implantation, and was more likely to be treated with repeat stenting than no tissue proliferation. Lipidic neointimal tissue and > 1 layer of stent were significant predictors of target SF during follow-up.