Mechanisms of Stent Failure: Lessons from IVUS and OCT

Despite significant advances in stent design and procedural technique, stent failure remains the “Achilles’ heel” of percutaneous coronary intervention (PCI). It is important to understand the mechanism of stent failure to prevent major adverse events and improve clinical outcomes. Two-dimensional angiography alone is insufficient for elucidating the etiology of stent failure. Intracoronary imaging modalities, including intravascular ultrasound (IVUS) and optical coherence tomography (OCT) have evolved to guide optimal stent placement during PCI, and have enabled identification of the etiology behind stent failure. In this review, we discuss the mechanisms of stent failure, use and limitations of intracoronary imaging (IVUS and OCT) to assess its etiology, and future directions for its use in patients undergoing coronary stent implantation.