What is the term for plaque protruding through a stent in a patient with a history of coronary artery disease?

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Tissue Protrusion

The term for plaque protruding through a stent is "tissue protrusion," defined as intra-stent protrusion of lesion tissue or atherothrombotic material into the lumen between the stent struts. 1

Definition and Mechanism

Tissue protrusion refers to the herniation of atherosclerotic plaque components through the spaces between stent struts after deployment. 1 This occurs when:

  • Necrotic core material and fibrotic tissue are forced through the stent mesh during balloon expansion 2
  • The stent struts fail to completely contain the underlying plaque burden 1
  • Soft plaque components (particularly necrotic core and fibrotic tissue) are more prone to prolapse compared to calcified plaque 2

Clinical Significance

The clinical consequences of tissue protrusion remain controversial, with conflicting data in the literature. 1

Risk Factors for Increased Clinical Impact:

  • Larger volume of protrusion is associated with potential adverse events 1
  • Acute coronary syndrome (ACS) settings show higher risk with tissue protrusion 1
  • Necrotic core component in prolapsed tissue correlates positively with cardiac enzyme elevation (CK-MB: r=0.489, p<0.001; troponin-I: r=0.679, p<0.001) 2

Plaque Components Most Likely to Protrude:

  • Necrotic core (NC) volume is independently associated with tissue protrusion development (OR=1.14, p<0.001) 2
  • Fibrotic tissue (FT) volume is independently associated with tissue protrusion (OR=1.09, p<0.001) 2
  • Fibrotic tissue is typically the largest component in prolapsed plaque, but necrotic core is also substantial 2

Distinction from Other Post-Stent Complications

Tissue protrusion must be distinguished from:

  • Stent malapposition: Lack of contact between stent struts and vessel wall, not protrusion of material through struts 1
  • Edge dissection: Tear in vessel wall at stent margins, not intra-stent tissue herniation 1
  • Stent underexpansion: Incomplete stent deployment without tissue prolapse 1

Assessment and Detection

Tissue protrusion is best identified using intravascular imaging (IVI):

  • Intravascular ultrasound (IVUS) can visualize tissue between stent struts 1
  • Optical coherence tomography (OCT) provides higher resolution for detecting tissue protrusion 1
  • Virtual histology-IVUS can characterize the specific plaque components within the prolapsed tissue 2

Clinical Management Considerations

While the evidence is conflicting regarding intervention necessity 1:

  • Minor tissue protrusion without flow limitation typically does not require additional intervention 1
  • Large volume protrusion in ACS settings warrants closer monitoring for potential complications 1
  • Post-dilation may reduce but not eliminate tissue protrusion 2
  • Cardiac biomarker elevation correlates with necrotic core content in prolapsed tissue, suggesting potential for distal embolization 2

References

1
Guideline

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Dr.Oracle Medical Advisory Board & Editors, 2025

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Professional Medical Disclaimer

This information is intended for healthcare professionals. Any medical decision-making should rely on clinical judgment and independently verified information. The content provided herein does not replace professional discretion and should be considered supplementary to established clinical guidelines. Healthcare providers should verify all information against primary literature and current practice standards before application in patient care. Dr.Oracle assumes no liability for clinical decisions based on this content.

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