Scenario IV – Stent Deployment and Malapposition

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Summary

Scenario IV – Stent Deployment and Malapposition
Optimal stent deployment is an important aspect of successful PCI because it has been well documented that stent malapposition can lead to subsequent stent thrombosis. The superior resolution of OCT (10–20 μm) gives it the distinct advantage of being able to reveal other vascular details that are beyond the capacity of IVUS (100–150 μm), such as tissue prolapse between stent struts or distal edge dissection.

Case 6
Age: 62
Gender: Male
History: Prior myocardial infarction, controlled hypertension, diabetes, hyperlipidaemia, a family history of coronary artery disease and prior stroke. Presented with CCS Class II angina while receiving two antianginal medications (verapamil and longacting nitrate).

• Cardiac catheterisation demonstrated a long, tubular stenosis of the proximal mid-LAD with minimal CSA demonstrated by an OCT of 1.9 mm² (not shown).
• PCI was performed with placement of a 3.0 x 38 mm stent and a very satisfactory result by angiography was achieved (see Figure 6A).
• OCT was performed after stent implantation; however, revealed gross stent malapposition (see Figure 6B).
• Based on OCT, the stent was post-dilated using a 4.0 x 15 mm non-compliant balloon.
• Final OCT after post-dilation showed optimal stent apposition (see Figure 6C).

In this case, OCT was able to diagnose stent malapposition and was used to guide the post-dilation strategy. OCT also confirmed optimal final stent apposition.