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Rivista sulle Malattie del Cuore e dei Vasi

Official Journal of the Italian Society of Angiology and Vascular Pathology
Indexed/Abstracted in: EMBASE, PubMed/MEDLINE, Science Citation Index Expanded (SciSearch), Scopus
Impact Factor 0,752

Periodicità: Bimestrale

ISSN 0026-4725

Online ISSN 1827-1618


Minerva Cardioangiologica 2016 Sep 27

Optical coherence tomography in drug-eluting stent restenosis: a technique in need of a strategy

Sebastian KUFNER 1, Erion XHEPA 1, Christoph LUTTER 2, Salvatore CASSESE 1, Michael JONER 1

1 Deutsches Herzzentrum München, Technische Universität München, Munich, Germany; 2 Department of Sports Orthopedics, Sports Medicine, Sports Traumatology, Department of Orthopedics and Traumatology, Klinikum Bamberg, Bamberg, Germany

Despite the high anti-restenotic efficacy of contemporary percutaneous interventional techniques, a substantial number of patients who undergo percutaneous coronary intervention (PCI) still present with restenosis. Despite iterations of devices– from plain balloon angioplasty to bare metal stenting (BMS) to drug-eluting stent (DES) therapy – have granted a progressive decline in the rate of this complication, in-stent restenosis remains a critical issue encountered in clinical practice. Owing to the overall increase in the use of DES, the number of patients presenting with DES restenosis is not insignificant in absolute terms. When DES restenosis occurs, it represents a challenging clinical entity in terms of classification and treatment. Optical coherence tomography (OCT) has been introduced as an innovative tool capable of providing high-resolution images of anatomical structures with high axial resolution (10-20 μm). By providing near histology-level images, intravascular OCT has been used to describe vascular responses following PCI. Subsequently, OCT has been introduced to assess neointimal morphology and tissue characteristics of restenotic lesions to clarify the underlying pathophysiology. So far, several parameters are in use to assess the morphology of neointimal tissue, including tissue structure, quality of backscattering light, and visible microvessels and the presence of intraluminal material. Due to physical properties of near-infrared light, OCT imaging provides excellent resolution in the near-catheter field, while limitations exist in circumferential penetration depth. Consequently, OCT imaging is best suited to reflect morphological characteristics of restenotic lesions, where its application enables to provide quantitative measures of neointimal growth and, more importantly, differentiate qualitative tissue properties amenable to specific treatment algorithms. In keeping with this, distinct morphological characteristics of BMS and DES restenotic lesions, as well as early, late and very late restenosis have been identified, emphasizing the ability of OCT to differentiate patterns of restenotic lesions by qualitative assessment. Finally, morphological assessment of restenotic lesions might entail dedicated treatment strategies and accomplish individualized patient-care. Whether the OCT- guided treatment of restenotic lesions might improve outcomes of this challenging clinical entity remains unanswered, since implementation and adequate treatment algorithms are matter of current debate.

lingua: Inglese


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