We investigated the incidences, predictors, and clinical outcomes of acute and late
stent malapposition detected by optical coherence tomography (OCT) after
drug-eluting stent implantation.
METHODS AND RESULTS: We analyzed the OCT images from 351 patients with 356 lesions who received poststent and follow-up OCT examinations. Acute
stent malapposition was observed in 62% of lesions. Approximately half of the acute
stent malappositions were located within the edges of the
stents. Severe diameter
stenosis, calcified lesions, and long
stents were independent predictors of acute
stent malapposition. Follow-up OCT examinations were performed 175±60 days after
drug-eluting stent implantation. Thirty-one percent of lesions with acute
stent malapposition remained malapposed (late-persistent
stent malapposition) and were typically (72%) located within the edges of the
stent. The location within the
stent edges and the volume of acute
stent malapposition were independent predictors of late-persistent
stent malapposition. Acute
stent malapposition with a volume >2.56 mm(3) differentiated late-persistent
stent malapposition from resolved acute
stent malapposition. Late-acquired
stent malapposition was detected in 15% of all lesions and was usually (61%) located within the
stent body. Late-acquired
stent malapposition was more frequently associated with plaque/
thrombus prolapse on poststent OCT images (70% versus 42%; P<0.001). Clinical events, including cardiovascular death, nonfatal
myocardial infarction, and
stent thrombosis, did not occur in patients with late
stent malapposition during the follow-up period of 28.6±10.3 months after
drug-eluting stent implantation.
CONCLUSIONS: Acute, late-persistent, and late-acquired
stent malapposition had relatively high incidences but different predictors. The clinical outcome of
stent malapposition was favorable.