Identification of coronary artery plaque rupture before stenting and stent edge dissection after stenting by optical coherence tomography and their management

Background: Optical coherence tomography (OCT) is a high-resolution imaging modality that can provide an accurate assessment of the coronary artery plaque rupture before stenting, or edge dissection after stenting, and may subsequently provide guidance for optimizing the stenting procedure. Methods: A total of 112 patients with coronary artery disease, who underwent OCT before and after percutaneous coronary intervention (PCI), were enrolled into the study. Interventional procedures were performed with the ameliorated deployment of stents according to OCT. Results: Before PCI, 101 coronary lesion sites were examined, in which 12 plaque ruptures involved in intima (11.9%) were detected by OCT and only four ruptures involved in intima (4.0%) were detected by CAG (P = 0.0327). All 12 OCT-detected plaque ruptures were limited to the intima. After PCI, 180 stent edges (89 proximal and 91 distal edges) were examined, in which 48 were OCT-detected edge dissections (26.7%, 48/180) and five were CAG-detected dissections (2.8%, 5/180) (P<0.0001). Among these 48 OCT-detected dissections, 23 lesions were involved in the adventitia. including 10 lesions at the proximal edge (35.7%, 10/28) and 13 lesions at the distal edge (65.0%, 13/20, P = 0.0433). Finally, four stents were deployed over the plaque ruptures due to OCT, and 13 stents were implanted over the OCT-detected edge dissections. Conclusion: OCT may detect plaque rupture missed by CAG, allow the thorough examination of stent edge dissections after PCI, and may subsequently provide guidance for optimizing the PCI procedure.