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

Abstract Chronic stent recoil, a late reduction in stent lumen dimensions following percutaneous coronary intervention (PCI), remains a significant challenge impacting long-term clinical outcomes. This serial optical coherence tomography (OCT) study aimed to comprehensively investigate the factors associated with chronic stent recoil occurring beyond six months post-implantation and to evaluate its impact on the need for repeat revascularization. We prospectively enrolled 200 patients undergoing PCI with contemporary drug-eluting stents (DES) and performed OCT imaging immediately post-procedure and at a follow-up angiography (median 12 months). Quantitative OCT analysis assessed stent dimensions, apposition, tissue coverage, and neointimal hyperplasia. Baseline clinical and angiographic characteristics were correlated with the degree of chronic stent recoil, defined as a ≥5% reduction in minimum stent diameter (MSD) between the two time points. The impact of significant chronic stent recoil on the incidence of target lesion revascularization (TLR) was also evaluated. Our findings identify specific procedural and anatomical factors, as well as patterns of neointimal healing, that are associated with chronic stent recoil and demonstrate its significant contribution to the need for repeat intervention. Keywords: Chronic stent recoil, Optical coherence tomography (OCT), Drug-eluting stents (DES), Percutaneous coronary intervention (PCI), Target lesion revascularization (TLR), Neointimal hyperplasia.