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Complications du stenting en OCT Christophe Caussin; Nicolas AMABILE IMM Paris Conflits dintrts Programme d enseignement / consultant ABBOTT ESC Recommendations 2018 Thrombose de stent Dissection iatrogne Deformation &

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

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

  3. ESC Recommendations 2018

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

  5. Thrombose de stent

  6. 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

  7. Initial Coronary Angiography

  8. OCT J3

  9. Mécanisme thrombose de stent: Malaposition

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

  11. Mécanisme thrombose de stent: Mailles non recouvertes

  12. Mécanisme thrombose de stent: Evagination tissulaire

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

  14. 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

  15. 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

  16. Iatrogenic dissection

  17. Barber-Chamoux N et al, Cardiovascular Revascularisation Medicine 2016

  19. Stent deformation

  20. Stent longitudinal compression

  21. Positionnement du guide

  28. 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

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

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

  31. 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

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