scholarly journals Impact of stent edge dissection detected by optical coherence tomography after current-generation drug-eluting stent implantation

PLoS ONE ◽  
2021 ◽  
Vol 16 (11) ◽  
pp. e0259693
Author(s):  
Hiroyuki Jinnouchi ◽  
Kenichi Sakakura ◽  
Tomonobu Yanase ◽  
Yusuke Ugata ◽  
Takunori Tsukui ◽  
...  
Keyword(s):  
Optical Coherence Tomography ◽  
Clinical Outcomes ◽  
Cardiac Death ◽  
Target Lesion ◽  
Drug Eluting Stent ◽  
Primary Study ◽  
Optical Coherence ◽  
Current Generation ◽  
Drug Eluting ◽  
Inverse Probability Weighted

Background Stent edge dissection (SED) is a well-known predictor of worse clinical outcomes. However, impact of SED after current-generation drug-eluting stent (DES) implantation remains unknown since there was no study using only current-generation DES to assess impact of SED. This study aimed to investigate a relationship between SED detected by optical coherence tomography (OCT) and clinical outcomes after current-generation DES implantation. Methods This study enrolled 175 patients receiving OCT after current-generation DES implantation. The SED group was compared with the non-SED group in terms of the primary study endpoints which was the cumulative incidence of major adverse cardiac event (MACE) composed of cardiac death, target vessel myocardial infarction (TV-MI), and clinically-driven target lesion revascularization (CD-TLR). Results Of 175 patients, SED detected by OCT was observed in 32 patients, while 143 patients did not show SED. In the crude population, the SED group showed a significantly higher incidence of CD-TLR, definite stent thrombosis, TV-MI and cardiac death relative to the non-SED group. After adjustment by an inverse probability weighted methods, the SED group showed a significantly higher incidence of MACE compared with the non-SED group (hazard ratio 3.43, 95% confidence interval 1.09–10.81, p = 0.035). Fibrocalcific or lipidic plaques, greater lumen eccentricity, and stent-oversizing were the predictors of SED. Conclusions SED detected by OCT after the current-generation DES implantation led to unfavorable outcomes. Aggressive post-dilatation around the stent edge might worse clinical outcomes due to SED, although achievement of optimal stent expansion is strongly encouraged to improve clinical outcomes.

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

125Incidence and outcomes of bailout stenting following use of drug coated balloon

2019 ◽  
Vol 40 (Supplement_1) ◽  
Author(s):  
S Basavarajaiah ◽  
S Handi ◽  
L Foley ◽  
R Watkin ◽  
B Freestone ◽  
...  
Keyword(s):  
Synergistic Effect ◽  
Stent Thrombosis ◽  
Cardiac Death ◽  
De Novo ◽  
Target Lesion ◽  
Drug Eluting Stent ◽  
Target Vessel ◽  
Current Recommendation ◽  
Drug Eluting ◽  
Drug Coated Balloon

Abstract Background The incidence of bailout stenting post-drug coated balloon use (DCB) in the literature has been more than 10%; ranging up-to 21% in Bello trial and this variation could be due to the different criteria used to consider bailout stenting and may also reflect aggressive pre-dilatation. Our eyes are trained to expect stent like result and anything less is considered sub-optimal and this could be one of the reasons for high incidence of bailout stenting. The current recommendation is to use drug eluting stent (DES) for bailout stenting and hence raising in the possibility of drug toxicity or maybe even synergistic effect from combination of Paclitaxel (DCB) and limus (DES). Aim We have evaluated the incidence and outcomes of patients needing bailout stenting in our centre. Methods and results We evaluated all patients who were treated with DCB between January 2016-August 2017. Bailout stenting per lesion were identified and studied for endpoints which included cardiac death, target vessel MI, stent thrombosis, target lesion revascularization and target vessel revascularisation. Between the study period; 468 lesions (in 364 patients) were treated with paclitaxel DCB (Sequent Please, B Braun, Germany). Bailout stenting was required in 23 lesions (4.9%) and of which 12 (52%) was for flow limiting dissections (type C or more) and the remaining 11 was for recoil of more than 50%. Majority of the lesions were de novo (18; 78%). All bailout stenting was performed with third generation limus eluting stents. During a median follow-up of 18.14 months; range; 7–33 months, there was no cardiac death and target vessel MI occurred in 1 patient (4.3%), TLR and TVR were in 3 lesions (13%). MACE rate (combination of cardiac death, target vessel MI and TVR) was 13%. There were no cases of stent thrombosis as per the ARC definition. Conclusion One of the highlighting features of our study is very low-rates of bailout stenting. This may be due to our criteria of not stenting mild dissections (unless they are flow limiting) and also to accepting recoil of up-to 50% post-DCB use. The outcome in bailout stenting group is acceptable especially with hard endpoints (cardiac death, target vessel MI and stent thrombosis) although TLR and TVR rates were higher indicating synergistic effect of paclitaxel and limus may not offer additional benefits.

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