Delayed coverage of drug-eluting stents after interventional revascularisation of chronic total occlusions assessed by optical coherence tomography: the ALSTER-OCT-CTO registry.

AIMS: Following percutaneous coronary interventions (PCI) for revascularisation of chronic total occlusions (CTO) patients are at increased risk for stent thrombosis (ST). Delayed drug-eluting stent (DES) coverage has previously been shown to be related to ST. Using optical coherence tomography (OCT), we tested the hypothesis that CTO-PCI is associated with delayed DES coverage compared to non-CTO lesions.

METHODS AND RESULTS: From 06/2010 to 11/2013, 105 patients (111 lesions) with clinically driven follow-up angiography after PCI with DES received an OCT analysis. Patients with successful CTO-PCI (19 patients/20 lesions, 6.5±2.1 months post PCI) were included in the CTO group, and patients with non-CTO lesions and total stent length >24 mm (28 patients/28 lesions, 4.9±2.2 months post PCI) were used as a control group. Struts were analysed by OCT (CTO vs. control, mean±SD): covered: 68.9±21.9% vs. 89.6±10.4%, p<0.001; uncovered apposed: 20.2±16.2% vs. 7.5±8.7%, p=0.001; uncovered malapposed: 10.9±10.3% vs. 2.9±2.6%, p<0.001. Neointimal thickness was 92.0±61.2 m vs. 109.3±39.2 m, p=0.033. No differences concerning different CTO-PCI approaches were found.

CONCLUSIONS: A significantly delayed DES coverage after CTO-PCI was observed. Given the known increased rate of ST following CTO-PCI and the known association between delayed DES coverage and ST, OCT may aid in determining the optimal duration of dual antiplatelet therapy after CTO-PCI.