The role of optical coherence tomography in detecting and correcting stent malapposition during primary percutaneous coronary intervention: A case series and review of current practice

Primary percutaneous coronary intervention (PCI) is the gold standard for treating acute myocardial infarction (AMI). Stent malapposition, a complication more common in AMI due to plaque disruption and thrombus burden, increases the risks of stent thrombosis and restenosis. Angiography often misses subtle malapposition due to its limitations. Optical coherence tomography (OCT), with high-resolution imaging, enhances detection and correction of stent malapposition. The case series presents four patients with proximal stent edge malapposition during primary PCI for AMI. Malapposition, undetected by angiography, was identified using OCT. Corrective measures, including postdilation with high-pressure balloons, were guided by OCT findings. OCT identified malapposition in all cases, leading to successful correction and optimal stent apposition. Follow-up showed no adverse events, confirming the role of OCT in improving outcomes by addressing angiography’s limitations. OCT is invaluable for detecting and correcting stent malapposition during PCI. Routine use of OCT, especially in complex cases, can optimize procedural outcomes and enhance patient safety.