Optical Coherence Tomographic Predictors of Clinical Outcomes after Coronary Chronic Total Occlusion Revascularization: Does Final Stent Size and Strut Apposition Matter?

Background:
Optical coherence tomography (OCT) has identified risk factors for adverse outcomes after non-Chronic Total Occlusion (CTO) lesion interventions. The final OCT results of CTO stenting is less studied.

Methods:
We retrospectively studied 17 patients with an OCT of a revascularized CTO lesion. Clinical outcomes were noted up to 1 year after the procedure. OCT parameters were recorded every 0.6mm along the stented segment. We defined significant strut malapposition as ≥5% of malapposed struts. Mild, moderate, severe malapposition depended on the malapposed strut area/reference stent area (MSA/RSA).

Results:
Eleven patients were suitable for assessment throughout the length of the stented CTO. Seven patients were male (64%) and 8 were African-American (72%). Malapposition was seen in 9 (82%) patients. 7488 struts were counted, and 661 struts were malapposed. Significant malapposition was seen in 6 patients (32%, 21%, 26%, 7%, 6%, and 5% on strut count). No stent edge malapposition was seen. Mean stent luminal areas were: RCA 5.54mm2±1.7, LCx 4.73mm2±0.06, LAD 6.18mm2±0.12. Eight patients (72%) had angina improvement. Significant stent malapposition did not affect outcomes when correlated with cardiac readmission, repeat angiogram, or angina improvement upon 1 year follow-up. Table 1 for individual details.

Conclusions:
The CTO interventions improved the patient’s angina. OCT identified significant strut malapposition in over half of the sample. No correlation was found between stent apposition and clinical outcomes.