Use of Optical Coherence Tomography to Determine the Optimal Management of Patients With Drug-eluting Stents Who Need Non-cardiac Surgery

Patients who receive drug-eluting stents (DES) and subsequently require non-cardiac surgery
have increased risk for perioperative stent thrombosis, especially when antiplatelet therapy
discontinuation is required. Perioperative administration of a glycoprotein IIb/IIIa
inhibitor may decrease the stent thrombosis risk, but it is cumbersome and carries high
cost. Stents that have been endothelialized by optical coherence tomography (OCT) are likely
to have low risk for perioperative stent thrombosis and therefore intensive management
strategies, such as "bridging with a glycoprotein IIb/IIIa inhibitor" would not be required.
The current study will assess whether OCT utilization can help optimize the preoperative
management of DES patients requiring major non-cardiac surgery.

The specific aim of this proposal is to examine the impact of OCT and IVUS-guided management
of patients with prior DES implantation who need major non-cardiac surgery and
discontinuation of dual antiplatelet therapy on the perioperative (1 week prior to surgery
until 30 days post surgery) incidence of major adverse cardiac events.

The hypothesis is that OCT and IVUS-guided treatment will have low incidence (≤10%) of
perioperative major adverse cardiac events.

The specific aim of this proposal is to examine the impact of OCT and IVUS-guided management
of patients with prior DES implantation who need major non-cardiac surgery and
discontinuation of dual antiplatelet therapy on the perioperative (1 week prior to surgery
until 30 days post surgery) incidence of major adverse cardiac events.

The hypothesis is that OCT and IVUS-guided treatment will have low incidence (≤10%) of
perioperative major adverse cardiac events.