Mechanisms of late stent-related myocardial infarction: insights from optical coherence tomography

This article focuses on optical coherence tomography findings in patients with late major cardiovascular events like myocardial infarction and/or stent thrombosis, following drug-eluting stent and bare-metal stent implantation. Uncovered stent struts and malapposition seem to play a critical role in drug-eluting stent-related late events. Neointimal features similar to native atherosclerosis are usually found in baremetal stent-related late events, although there is increasing evidence that this may also happen with drug-eluting stents, but with a different chronology. The role of optical coherence tomography in exploring the mechanisms of such late events, and its potential role in percutaneous coronary intervention optimization guided by these presumed mechanisms, is further discussed.