Segments with ISA detachment distance of 100-300 μm had 6.1% uncovered struts while those >300 μm had 15.7% uncovered, indicating more ISA increases coverage delay (P < 0.001).
Does the severity of incomplete stent apposition (detachment distance) affect shear flow disturbances and delayed neointimal coverage in patients undergoing PCI?
Incomplete stent apposition with a detachment distance >100 μm significantly increases shear flow disturbances and the risk of delayed neointimal strut coverage at 6 months.
Absolute Event Rate: 0% vs 0%
Background— Lack of re-endothelialization and neointimal coverage on stent struts has been put forward as the main underlying mechanism leading to late stent thrombosis. Incomplete stent apposition (ISA) has been observed frequently in patients with very late stent thrombosis after drug eluting stent implantation, suggesting a role of ISA in the pathogenesis of this adverse event. The aim of this study was to evaluate the impact of different degrees of ISA severity on abnormal shear rate and healing response with coverage, because of its potential implications for stent optimization in clinical practice. Methods and Results— We characterized flow profile and shear distribution in different cases of ISA with increasing strut-wall detachment distance (ranging from 100 to 500 μm). Protruding strut and strut malapposed with moderate detachment (ISA detachment distance 300 μm had 6.1% and 15.7% of their struts still uncovered at follow-up, respectively ( P <0.001). Conclusions— Flow disturbances and risk of delayed strut coverage both increase with ISA detachment distance. Insights from this study are important for understanding malapposition as a quantitative, rather than binary phenomenon (present or absent) and to define the threshold of ISA detachment that might benefit from optimization during stent implantation.
Foin et al. (Wed,) reported a other. Segments with ISA detachment distance of 100-300 μm had 6.1% uncovered struts while those >300 μm had 15.7% uncovered, indicating more ISA increases coverage delay (P < 0.001).