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Incomplete stent apposition (ISA) is characterized by the lack of contact of at least 1 stent strut with the vessel wall in a segment not overlying a side branch; it is more commonly found in drug-eluting stents than bare-metal stents. The accurate diagnosis of ISA, initially only possible with intravascular ultrasound, can currently be performed with higher accuracy by optical coherence tomography, which also enables strut-level assessment due to its higher axial resolution. Different circumstances related both to the index procedure and to vascular healing might influence ISA occurrence. Although several histopathology and clinical studies linked ISA to stent thrombosis, potential selection bias precluded definitive conclusions. Initial studies usually performed single time point assessments comparing overall ISA percentage and magnitude in different groups (i.e., stent type), thus hampering a comprehensive understanding of its relationship with vascular healing. Serial intravascular imaging studies that evaluated vascular response heterogeneity recently helped fill this gap. Some particular clinical scenarios such as acute coronary syndromes, bifurcations, tapered vessels, overlapping stents, and chronic total occlusions might predispose to ISA. Interventional cardiologists should be committed to optimal stent choices and techniques of implantation and use intravascular imaging guidance when appropriate to aim at minimizing acute ISA. In addition, the active search for new stent platforms that could accommodate vessel remodeling over time (i.e., self-expandable stents) and for new polymers and/or eluting drugs that could induce less inflammation (hence, less positive remodeling) could ultimately reduce the occurrence of ISA and its potentially harmful consequences.

Bifurcation angle (BA) influences incomplete stent apposition (ISA) at side branch ostium after kissing balloon inflation (KBI). Although BA can be measured by various methods, this study investigated whether 3-dimensional (3D)-optical coherence tomography (OCT) bifurcation types could predict ISA

A previous optical coherence tomography (OCT) study showed that incomplete stent apposition (ISA) of drug eluting stents is a major risk factor for stent thrombosis. The cobalt-chromium everolimus-eluting stent (CoCr- EES) incorporating a highly biocompatible stent is used in combination with short

Persistent or late acquired incomplete stent apposition (ISA) may be associated with late or very late stent thrombosis following drug-eluting stent implantation. Presence of calcium at the target lesion may increase the risk of ISA even after rotational atherectomy (RA) followed by stenting with

Several clinical and pathological studies have suggested an association between incomplete stent apposition (ISA) and delayed neointimal healing and adverse events (stent thrombosis).The aim of this study was to evaluate the impact of strut apposition and stent design on progression of stent strut

Objectives We sought to identify the frequency of incomplete stent apposition (ISA) in sirolimus-eluting stents (SES) and clarify its findings and clinical sequelae. Background Late-acquired ISA has been reported in bare-metal stents (BMS) and brachytherapy and recently in drug-eluting stents. However, the characteristics of late ISA in SES have not been clarified. Methods From the SIRIUS trial, a randomized, multicenter study comparing SES and BMS, serial qualitative intravascular ultrasound (IVUS; at stent implantation and eight-month follow-up) was available in 141 patients (BMS: n = 61; SES: n = 80). The IVUS images were reviewed for the presence of ISA. Results Incomplete stent apposition at follow-up was observed in 19 patients (BMS: n = 6 [9.8%]; SES: n = 13 [16.3%]; p = NS). Among these, 12 had ISA after intervention and at follow-up (persistent ISA). Late-acquired ISA was seen in the remaining seven cases, all from the SES group (BMS: n = 0; SES: n = 7 [8.7%]; p Conclusions Late ISA was observed in 8.7% of patients after SES implantation. There were no negative clinical events associated with this IVUS finding at 12-month clinical follow-up; however, careful long-term follow-up will be necessary.

Patients with ST-segment elevation myocardial infarction (STEMI) have an increased risk of incomplete stent apposition after drug-eluting stent implantation. The vascular response was assessed after treatment with the third generation biolimus-eluting Nobori stent with biodegradable polymer compared

The vascular tissue reaction to acute incomplete stent apposition (ISA) is scarcely known. The aim of this study is characterizing the vascular response to acute ISA in vivo and looking for predictors of incomplete healing. Optical coherence tomography studies from 3 randomized trials including

Preamble......1479 The present document is an Expert Consensus Document that includes evidence about the standards for the acquisition, measurement, and reporting of intravascular ultrasound studies (IVUS). This document is intended to inform practitioners, payers, and other interested parties of

Kunihiro Shimamura 1 , Takashi Akasaka 1 , Keiichi Igarashi 2 , Yasushi Ino 1 , Kazushige Kadota 3 , Masaki Kawamura 4 , Kazuo Kimura 5 , Takeshi Kimura 6 , Ken Kozuma 7 , Takashi Kubo 8 , Akiyoshi Miyazawa 9 , Yoshihiro Morino 10 , Yuji Sakanoue, Toshiro Shinke, Shinjo Sonoda, Tetsuya Sumiyoshi, Kengo Tanabe 1 Wakayama Medical University, Wakayama, Japan, 2 Hokkaido Social Insurance Hospital, Sapporo, Japan, 3 Kurashiki Central Hospital, Kurashiki, Japan, 4 Yokkaichi Social Insurance Hospital, Yokkaichi , Japan, 5 Yokohama City University Medical Center, Yokohama, Japan, 6 Kyoto University, Kyoto, Japan, 7 Teikyo University Hospital, Tokyo, Outside US, Wakayama Medical University, Wakayama, Wakayama, Iwatsuki Minami Hospital, Saitama, Japan, iwate medical university, morioka, Japan, 11 Higashisumiyoshi Morimoto Hospital, OSAKA, Japan, 12 Kobe University Graduate School of Medicine, Kobe-city, Hyogo, 13 University of Occupational and Environmental Health, Kitakyushu, Japan, 14 Sakakibara Heart Institute, Tokyo, Japan, 15 Mitsui Memorial Hospital, Tokyo, Japan