Differential Vascular Responses to New-Generation Drug-Eluting Stenting According to Clinical Presentation: Three-Month Optical Coherence Tomographic Study

Angiology ◽  
2020 ◽  
pp. 000331972098060
Author(s):  
Seung-Jun Lee ◽  
Sung-Jin Hong ◽  
Byeong-Keuk Kim ◽  
Chul-Min Ahn ◽  
Jung-Sun Kim ◽  
...  
Keyword(s):  
Significant Risk ◽  
Early Period ◽  
Significant Risk Factor ◽  
Drug Eluting Stent ◽  
Optical Coherence ◽  
Vascular Responses ◽  
Drug Eluting ◽  
Severe Degree ◽  
Uncovered Strut ◽  
New Generation

We evaluated early vascular responses after new-generation drug-eluting stent (DES) implantation. From 2 randomized trials, we identified 471 patients (138 patients with acute myocardial infarction [AMI] vs 333 patients with stable angina or unstable angina [SA/UA]) treated by DESs who underwent serial optical coherence tomography (OCT) from postprocedure to 3 months. At 3-month follow-up OCT, malapposed strut percentage was higher in AMI than in SA/UA (5.3% vs 0.7%, P < .001); it was markedly increased from postprocedure in AMI (2.0%-5.3%, P < .001), whereas it decreased in SA/UA (1.7%-0.7%, P < .001). Patients with AMI showed a higher risk of persistent (59% vs 37%; P < .001) or late-acquired malapposition (15% vs 8%; P = .04). Uncovered strut percentage at 3 months was also higher in AMI than in SA/UA (13.1% vs 6.7%, P < .001). The AMI presentation was the significant risk factor for both significant stent malapposition (SM, ≥200 μm; odds ratio [OR] = 3.45, CI = 1.85-7.14, P < .001) and uncovered stent (% uncovered struts >6.0%; OR = 2.44, CI = 1.35-4.76, P = .004), together with malapposed distance and postprocedural thrombi. Further, AMI presentation was the predictor for the occurrence of early period late-acquired and persistent malapposition. Serial OCT comparison analyses showed that patients with AMI compared with patients with SA/UA showed more delayed strut coverage, more severe degree SM or uncovered stents, and higher incidences of early period persistent or late-acquired SM.

Impact of hinge motion on stent edge restenosis after new generation drug-eluting-stent implantation in RCA

2020 ◽  
Vol 41 (Supplement_2) ◽  
Author(s):  
T Jimba ◽  
M Ikutomi ◽  
D Nishijyo ◽  
M Yamasaki ◽  
A Shindou ◽  
...  
Keyword(s):  
Stent Implantation ◽  
Biomechanical Properties ◽  
Plaque Burden ◽  
Drug Eluting Stent ◽  
Landing Zone ◽  
Binary Restenosis ◽  
Drug Eluting ◽  
New Generation ◽  
Hinge Angle

Abstract Background Edge restenosis still occurs after stent implantation, even by using new generation drug-eluting stents (DES) considered to have favorable biomechanical properties. Mechanical stress imposed on the stent edge are thought to be aggravated by hinge motion at a point between the stented and unstented segments, inducing chronic local inflammation and neointimal overgrowth. Purpose The aim of this study was to investigate the association between the development of edge restenosis and hinge motion in right coronary artery (RCA) where the excessive vessel movement is commonly observed. Methods Among consecutive 650 lesions in RCA where new generation DESs were implanted between 2009 and 2019, 427 serial lesions with sets of angiographies at baseline and follow-up (6–18 month) were included. In addition to conventional quantitative angiography analysis, hinge angle at stent edges was measured (Fig. 1). All the appropriate data for intravascular imaging were analyzed for both stent edges and reference segments. Results Binary restenosis occurred in 43 lesions, and 39 of them were referred to re-intervention. Fifty five percent of them were related to stent edges (15 at proximal and 9 at distal edges). Classical risk factors including diabetes and hemodialysis were more prevalent in the restenosis group (p&lt;0.05). Hinge angle was statistically larger in edge restenosis group than body restenosis or no restenosis group (17.3° vs 11.6° vs 10.6°, p&lt;0.001, Fig. 2). In per-edge analysis, hinge angle, dissection and residual plaque ratio were the independent predictors for binary restenosis (Table 1) with the optimal cut-off value of hinge angle 11.5°. The coexistence of excessive hinge angle and residual plaque burden had an amplified effect on the angiographic stenotic progression at stent edge (p for interaction &lt;0.001) and the incidents of binary restenosis (16.7% vs 1.7% p&lt;0.01, Figs. 3,4). Conclusion Substantial stress determined by angulation at the stent edge and its interaction with residual plaque can be considered as one of the plausible mechanisms for edge restenosis. For tortuous RCA lesions, it would be important to decide the stent-landing zone for minimizing hinge motion and optimize the future stent design. Funding Acknowledgement Type of funding source: None

Neointimal Coverage on Drug-Eluting Stent Struts Crossing Side-Branch Vessels Using Optical Coherence Tomography

2010 ◽  
Vol 105 (11) ◽  
pp. 1565-1569 ◽  
Author(s):  
Ae-Young Her ◽  
Byoung Kwon Lee ◽  
Jae-Min Shim ◽  
Jung-Sun Kim ◽  
Byoung-Keuk Kim ◽  
...  
Keyword(s):  
Optical Coherence Tomography ◽  
Side Branch ◽  
Drug Eluting Stent ◽  
Optical Coherence ◽  
Drug Eluting ◽  
Neointimal Coverage

scholarly journals Optical Coherence Tomographic Analysis of In-Stent Neoatherosclerosis After Drug–Eluting Stent Implantation

Circulation ◽  
2011 ◽  
Vol 123 (25) ◽  
pp. 2954-2963 ◽  
Author(s):  
Soo-Jin Kang ◽  
Gary S. Mintz ◽  
Takashi Akasaka ◽  
Duk-Woo Park ◽  
Jong-Young Lee ◽  
...  
Keyword(s):  
Stent Implantation ◽  
Drug Eluting Stent ◽  
Optical Coherence ◽  
Drug Eluting ◽  
Tomographic Analysis
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