1. Optical Coherence Tomography Assessment of the Effect of High-pressure Non-compliant Balloon Postdilation on Underexpansion and Malapposition in Drug-eluting Stents

    Optical Coherence Tomography Assessment of the Effect of High-pressure Non-compliant Balloon Postdilation on Underexpansion and Malapposition in Drug-eluting Stents
    Concerns of an increased risk of thrombosis in drug-eluting stents (DES) and the association, in human pathology studies of stent thrombosis, of delayed healing with malapposition of stent struts has fostered a renewed interest in stent implantation optimisation techniques. We investigated the rationale of the use of optical coherence tomography (OCT), an intravascular imaging technique with 10-fold better resolution than intravascular ultrasound (IVUS), in the guidance of percutaneous coronary intervention (PCI) with respect to the correction of stent underexpansion and malapposition in DES. In 12 patients with OCT characteristics of frank malapposition immediately after DES implantation, high-pressure postdilation with a ...
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    On 11/23/11 mebrezin said:
    This study is a confirmatory observation which is nice, but the field has been for years in desperate need of outcomes studies. Outcomes studies effect patient management because look at the effects of patient parameters (stent position) and not outcomes. In the BES, maximum expansion was critical. In the era of DES, it does not seem to be case but it is not addressed here. Essentially as a cardiologist, the only point I need to know is whether improved expansion of the stent effects the incidence of late occlusion Not addressed here. This confirms IVUS work, DES stents aren't maximally expanded, but does it matter. This criticism is not a unique to these authors. OCT has been in patient arteries for approaching 12 years. But studies that look at outcome are almost non-existent on a relative scale. Outcome studies are more work because you have to follow patients and statistical analysis is more challanging (as well as design). Does this change patient management? As far as I can see no. If this was an outcome study, publishing the year 1 results gives you the same information here, plus you know outcomes at the end of the study. These observational studies make for great pictures, but it long been time to answer whether outcomes change.

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