BASICS Meeting , 23rd April 2015, Belgrade
Conflict of interest : Dr Nicolas Amabile, received some consulting fees from St Jude Medical, Boston Scientific and Astra Zeneca.
Cliquer sur les images pour agrandir / Click images to enlarge
A 75 years old man was referred to our center for acute lateral STEMI.
Previous Medical History:
Dyslipidemia under statin therapy
Previous PCI (9 years before) on Dg1 with DES (Cypher° 2.5 x 18 mm) for stable angina
Antiplatelet therapy : aspirin 75mg/d since 2003
Initial Coronary Angiography following successful thrombolysis
Extremely late drug eluting stent thrombosis
Correct struts coverage of the distal part of the stent.
Evidences of uncovered + malapposed struts on the proximal part of the stent.
Probable late-acquired malapposition of the Cypher Device.
Medical therapy : Initial Anticoagulation (LMWH) + Double APT (ticagrelor+ aspirin)
Prolonged DAPT after Hospital discharge
Is stent thrombosis still an issue ?
ST is a multifaceted process
What can we expect from OCT in ST ?
To assess the diagnosis
To identify the underlying mechanism
To guide treatment.
Isolated uncovered struts
Edge related disease progression
ISR without neoatheroma
What do the studies tell us ?
Neoatherosclerosis in VLST
N=33 patients with VLST (52% STEMI, 33% NSTEMI, 15% UA)
OCT analysis before thrombus aspiration
What about the “big picture” ?
According to the operators, ST mechanism could be certainly assessed by coronary angiography alone in 14 % of the patients
Does OCT use change ST management strategy ?
OCT in 2014 ESC guidelines
OCT is currently the best available imaging technique to explore stent thrombosis.
OCT allows us to better understand the pathophysiology of ST and discover new late stent failure mechanisms (neoatherosclerosis, evaginations..).
As OCT helps the physician to correctly identify the underlying stent mechanical abnormalities, it also supports an adapted treatment strategy that could improve outcome.