Unintended Deformation of Stents During Bifurcation PCI: An OCTOBER Trial Substudy

Unintended Deformation of Stents During Bifurcation PCI: An OCTOBER Trial Substudy

Background

Unintended deformation of implanted coronary stents can lead to complications such as loss of coronary access, stent thrombosis, and coronary events during follow-up. The incidence, mechanisms, and clinical outcomes of unintended stent deformations (USD) during complex bifurcation stenting are not well understood.

Objectives

In a prespecified analysis of the OCTOBER trial, the study aimed to determine the incidence and characterize mechanisms of USD identified by optical coherence tomography (OCT) and evaluate physician’s detection and correction of accidental abluminal rewiring and USD.

Results

USD was identified in 9.3% of OCT-guided cases, with accidental abluminal rewiring and guide catheter collision being the primary causes. Left main bifurcation percutaneous coronary intervention was associated with a particular risk, with USD detected in 18.5% of cases. The study found that untreated USD was associated with a 2-year major adverse cardiac event rate of 23.3%, while patients with confirmed or possibly corrected USD had no events during follow-up.

Conclusions

USD was linked to adverse procedural complications and cardiac events when not identified and corrected. The predominant mechanisms were undetected abluminal rewiring and guide catheter collision.

PMID:38749590 | DOI:10.1016/j.jcin.2024.03.013

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