Key result
OCT-diagnosed strut fractures are linked to ~25-fold higher odds of DES complications.
Why the study?
The frequency, characteristics, and clinical implications of coronary stent strut fractures remain incompletely understood.
Are strut fractures detected by OCT associated with an increased risk of device failure in patients treated with coronary stents or bioresorbable scaffolds?
Cross-Sectional (n=458)
Yes
Are strut fractures detected by OCT associated with an increased risk of device failure in patients treated with coronary stents or bioresorbable scaffolds?
Strut fractures identified by OCT are far more prevalent in the setting of device failure compared to routine controls, and serve as a strong independent correlate for stent restenosis and thrombosis.
Answers are grounded in this paper and cite their sources.
Strut fractures on OCT associate with device failure; leaves open whether targeted surveillance improves outcomes in calcific or bifurcation lesions.
Introduction. The frequency, characteristics and clinical implications of Strut fractures (SFs) remain incompletely understood. Methods and results. A total of 185 (160 patients) newer-generation drug-eluting stents (DES) were imaged. SFs were found in 21 DES (11.4%) and were classified in four patterns: one single stacked strut (41%); two or more stacked struts (23%); deformation without gap (27%); transection (9%). In multivariable analysis, calcific and bifurcation lesions were associated with SF in DES (OR: 3.5 [1.1–11] and 4.0 [2.2–7.2], p < 0.05). Device eccentricity and asymmetry as well as optical coherence tomography (OCT) features of impaired strut healing were also associated with SF. The prevalence of fractures was similar in a set of 289 bioresorbable scaffolds (BRS). In a separate series of 20 device thromboses and 36 device restenoses, the prevalence of SF was higher (61.2% of DES and 66.7% of BRS, p < 0.001 for both), with a higher frequency of complex SF patterns (p < 0.0001). In logistic regression analysis, fractures were a correlate of device complications (p < 0.0001, OR = 24.9 [5.6–111] for DES and OR = 6.0 [1.8–20] for BRS). Discussion. The prevalence of OCT-diagnosed SF was unexpectedly high in the setting of elective controls and it increased by about three-fold in the setting of device failure. Fractures were associated with increased lesion complexity and device asymmetry/eccentricity and were more frequent in the setting of device failure such as restenosis and thrombosis.
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Schochlow et al. (2021) conducted a cross-sectional in Coronary artery disease treated with stents or scaffolds (n=458). Strut fracture vs. No strut fracture was evaluated on Device complications (restenosis or thrombosis) (OR 24.9, 95% CI 5.6-111, p=<0.0001). OCT-diagnosed strut fractures were strongly correlated with device complications such as restenosis and thrombosis in drug-eluting stents (OR 24.9) and bioresorbable scaffolds (OR 6.0).
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