Factors Associated With Chronic Stent Recoil and its Impact on Revascularization: A Serial Optical Coherence Tomography Study

Abstract

Background: Chronic stent recoil can vary according to both stent materials and designs.

Objectives: The authors sought to use serial optical coherence tomography (OCT) to investigate the incidence of chronic stent recoil and its impact on target lesion revascularization (TLR) in second- or newer-generation drug-eluting stent implantation.

Methods: Patients undergoing clinically indicated serial OCT studies (baseline and either at TLR or after more than 6-month follow-up) were studied. Chronic stent recoil was defined as >10% stent volume reduction (over a 10-mm length centered at the maximum recoil site) without fracture or deformation or >10% reduction in cross-sectional stent area with fracture or deformation.

Results: Chronic stent recoil occurred in 21.5% (35/163) of lesions undergoing TLR and 7.8% (8/102) of lesions not undergoing TLR during a median of 16.1 (Q1-Q3: 10.1-29.4) months following baseline OCT. In a multivariable generalized logistic mixed model, larger maximum calcium arc (per 90°, OR: 1.64; 95% CI: 1.17-2.29), greater baseline stent expansion (per 10%, OR: 1.41; 95% CI: 1.19-1.83), and greater stent eccentricity index (per 0.1, OR: 0.61; 95% CI: 0.39-0.92) were associated with an increased risk for chronic stent recoil. Greater chronic stent recoil (per 1 mm², OR: 3.86; 95% CI: 1.57-9.48), greater in-stent tissue growth (per 1 mm², OR: 4.26; 95% CI: 2.83-6.41), and baseline smaller minimum stent area (1 mm², OR: 0.38; 95% CI: 0.28-0.51) were associated with TLR.

Conclusions: Chronic stent recoil after second- or new-generation drug-eluting stent implantation occurred in 1 of 5 lesions undergoing TLR and was associated with TLR.

Keywords: chronic stent recoil; optical coherence tomography; second-generation drug-eluting stent(s); target lesion revascularization.