The correlation of tissue prolapse and neointimal proliferation after drug-eluting stent implantation by optical coherence tomography

Abstract

Background: Tissue prolapse after coronary stenting is frequently visible with optical coherence tomography (OCT), while its implications are still unknown. We investigated the association of tissue prolapse immediate after stent implantation and neointimal proliferation over stent at follow-up OCT examination. Methods: Between Feb 2008 to July 2012, a total 352 consecutive patients who underwent OCT examination after post stenting and follow-up in a OCT registry. The tissue prolapse immediate after stenting and neointimal proliferation and stent strut coverage at follow-up were quantitatively assessed with OCT examination. The tissue prolapse were classified into 3 groups according to the severity. Results: Median OCT follow up period was 181days (interquartile range 109-196). Tissue prolapse was visible in 313/352 (88.9%). Mean tissue prolapse length was 1.23±1.19mm. OCT-based tissue prolapse was related with uncovered stent struts (r=-0.22, p=0.000), lesion length (r=0.32, p<0.000), Instent Restenosis (r=0.14, p=0.029) and neointimal proliferation (r=0.16, p=0.002). Conclusions: High-pressure stenting techniques have been proved to reduce the risk of restenosis and subacute thrombosis. However, this strategy may also increase the vessel damage in the stented segment. Our study confirmed that the tissue prolapse was significant association with neointimal proliferation as well as might improve the stent strut coverage.