scholarly journals Comparison of Intravascular Imaging and Quantitative Coronary Angiography to Evaluate Neointimal Proliferation after Complex Lesion Stenting

2009 ◽  
Vol 63 (4-5) ◽  
pp. 168-173
Author(s):  
Sanda Jēgere ◽  
Inga Narbute ◽  
Indulis Kumsārs ◽  
Iveta Mintāle ◽  
Iļja Zakke ◽  
...  
Keyword(s):  
Coronary Angiography ◽  
Quantitative Coronary Angiography ◽  
Drug Eluting Stent ◽  
Intravascular Imaging ◽  
Chronic Total Occlusions ◽  
Neointimal Proliferation ◽  
Drug Eluting ◽  
Ivus Image ◽  
Uncovered Stent

Comparison of Intravascular Imaging and Quantitative Coronary Angiography to Evaluate Neointimal Proliferation after Complex Lesion Stenting Unlike quantitative coronary angiography (QCA), intravascular imaging methods allow direct visualisation of the arterial wall. Our goal was to determine several intravascular ultrasound (IVUS) and optical coherence tomography (OCT) parameters of neointimal proliferation and stent endothelisation after complex lesion intervention compared to QCA. We examined 261 patients who had underwent percutaneous intervention with bare metal (BMS) or drug eluting stent (DES) implantation for complex coronary lesions and had IVUS or OCT images at six-month follow-up. Percent diameter stenosis (QCA) was 25.2 ± 16.0 in BMS vs 21.7 ± 17.4 in DES (P < 0.05). Percent neointimal volume obstruction (IVUS) was 19.5 ± 14.4 in BMS vs. 5.8 ± 7.7 in DES (P < 0.001). A moderate correlation was observed between QCA and IVUS with an r value of 0.384 overall, 0.472 for BMS and 0.416 for DES (P < 0.001 for all). In patients with chronic total occlusions (n = 161) QCA was similar in BMS and DES patients (P > 0.05) while IVUS showed less neointima in DES (P < 0.05). Total number of uncovered stent struts per OCT image was 0.4 ± 0.8 while per IVUS image 1.2 ± 1.5 (P < 0.001). In conclusion, angiographic indexes correlate with volumetric intravascular parameters. Although IVUS was more sensitive than QCA to assess neointimal proliferation, the assessment of stent endothelisation was more precise using OCT.

Abstract 12989: Generalizability of Quantitative Angiographic In-Segment Late Lumen Loss Imaging in Eastern and Western Populations: Can We Facilitate Global Drug Eluting Stent Evaluation?

Circulation ◽  
2014 ◽  
Vol 130 (suppl_2) ◽  
Author(s):  
Vaishnavi Radhakrishnan ◽  
John C Allen ◽  
Rebecca Fisher ◽  
Weng Kit Lye ◽  
Robert W Harrison ◽  
...  
Keyword(s):  
Coronary Angiography ◽  
Propensity Score ◽  
Quantitative Coronary Angiography ◽  
Drug Eluting Stents ◽  
Drug Eluting Stent ◽  
Meaningful Difference ◽  
Late Lumen Loss ◽  
Drug Eluting ◽  
East And West

Background: Regulators require mechanistic observations of late lumen loss (LLL) in evaluating new drug eluting stents (DES). Redundant requirements for follow-up catheterization across regulatory jurisdictions worldwide could be reduced if independent core laboratory quantitative coronary angiography (QCA) findings were generalizable. Our study aim was to assess comparability of QCA LLL in East (Japan, China) and West (N. America, Europe) pts using the world’s largest compilation of late follow-up QCA data. Hypothesis: The propensity adjusted mean difference in QCA in-segment LLL between East and West is ≤0.4mm, with 95% confidence. Methods: All available data from 4 manufacturers (7157 pts, 29 trials) reporting 6-12mo QCA LLL were compiled. East vs West were compared unadjusted and via propensity score (PS) quartiles that adjusted for 26 clinical descriptive and anatomic variables affecting QCA LLL. Of the 7157 pts, 6163 (86%) had complete covariable profiles and comprised the analysis set. Based on consensus of experts and regulators, a clinically meaningful difference between East and West mean IS-LLL was prospectively set at 0.4mm. Results: Of 6163 pts, 4134 were West and 2029 East, including 2304 paclitaxel, 1455 everolimus, 1562 zotarolimus, 440 sirolimus and 402 biolimus exposures. Unadjusted and adjusted IS-LLL (Mean±SD) was 0.25±0.47 (W) and 0.08±0.41 (E), and 0.24±0.45 (W) and 0.13±0.45 (E), respectively; differences (95% CI) were 0.17 (0.15, 0.19) and 0.12 (0.08, 0.16), respectively. PS-adjusted IS-LLL is shown the Figure. All differences were ≤ 0.4mm. Conclusion: In the world’s largest compilation of protocol follow-up across multiple DES platforms, QCA LLL appears generalizable and sufficiently predictive across East and West pts in both unadjusted and adjusted comparisons. This suggests that global DES evaluations can be facilitated by reducing the need for redundant invasive late catheterization across regulatory jurisdictions.

scholarly journals Quantitative coronary angiography versus intravascular ultrasound guidance for drug-eluting stent implantation (GUIDE-DES): study protocol for a randomised controlled non-inferiority trial

BMJ Open ◽  
2022 ◽  
Vol 12 (1) ◽  
pp. e052215
Author(s):  
Pil Hyung Lee ◽  
Soon Jun Hong ◽  
Hyun-Sook Kim ◽  
Young won Yoon ◽  
Jong-Young Lee ◽  
...  
Keyword(s):  
Coronary Angiography ◽  
Intravascular Ultrasound ◽  
Stent Implantation ◽  
Ultrasound Guidance ◽  
Medical Center ◽  
Significant Coronary Artery Disease ◽  
Quantitative Coronary Angiography ◽  
Target Lesion ◽  
Drug Eluting Stent ◽  
Drug Eluting

IntroductionAngiography remains the gold standard for guiding percutaneous coronary intervention (PCI). However, it is prone to suboptimal stent results due to the visual estimation of coronary measurements. Although the benefit of intravascular ultrasound (IVUS)-guided PCI is becoming increasingly recognised, IVUS is not affordable for many catheterisation laboratories. Thus, a more practical and standardised angiography-based approach is necessary to support stent implantation.Methods and analysisThe Quantitative Coronary Angiography versus Intravascular Ultrasound Guidance for Drug-Eluting Stent Implantation trial is a randomised, investigator-initiated, multicentre, open-label, non-inferiority trial comparing the quantitative coronary angiography (QCA)-guided PCI strategy with IVUS-guided PCI in all-comer patients with significant coronary artery disease. A novel, standardised, QCA-based PCI protocol for the QCA-guided group will be provided to all participating operators, while the PCI optimisation criteria will be predefined for both strategies. A total of 1528 patients will be randomised to either group at a 1:1 ratio. The primary endpoint is the 12-month cumulative incidence of target-lesion failure defined as a composite of cardiac death, target-vessel myocardial infarction or ischaemia-driven target-lesion revascularisation. Clinical follow-up assessments are scheduled at 1, 6 and 12 months for all patients enrolled in the study.Ethics and disseminationEthics approval for this study was granted by the Institutional Review Board of Asan Medical Center (no. 2017-0060). Informed consent will be obtained from every participant. The study findings will be published in peer-reviewed journal articles and disseminated through public forums and academic conference presentations. Cost-effectiveness and secondary imaging analyses will be shared in secondary papers.Trial registration numberNCT02978456.

scholarly journals Influence of dual antiplatelet therapy duration on neointimal condition after second-generation drug-eluting stent implantation

2021 ◽  
Author(s):  
Yutaka Goryo ◽  
Teruyoshi Kume ◽  
Hiroshi Okamoto ◽  
Ai Kawamura ◽  
Kenzo Fukuhara ◽  
...  
Keyword(s):  
Antiplatelet Therapy ◽  
Stent Implantation ◽  
Second Generation ◽  
Dual Antiplatelet Therapy ◽  
Drug Eluting Stent ◽  
Similar Degree ◽  
Neointimal Proliferation ◽  
Stent Strut ◽  
Drug Eluting

AbstractGuidelines recommend shorter duration (1–12 months) for dual antiplatelet therapy (DAPT) in the second-generation drug-eluting stent (DES) era. However, whether shorter DAPT duration affects stent strut conditions and neointimal characteristics at mid-term follow-up remains uncertain. Therefore, we studied the relation between DAPT duration and vascular healing response as assessed by optical coherence tomography (OCT). This study was retrospective observational study. Participants comprised 64 patients who underwent serial OCT at both 9 and 18 months after DES implantation. All patients received DAPT until the 9-month follow-up then were divided into two groups: 49 patients who continued DAPT (longer DAPT group); and 15 patients who stopped taking the P2Y12 inhibitor and were treated with aspirin alone (shorter DAPT group) at the 18-month follow-up. Using OCT, we evaluated and compared stent strut conditions and neointimal characteristics between groups at both 9 and 18 months after stent implantation. Baseline clinical and procedural parameters were mostly similar between groups. At the 18-month follow-up, no in-stent thrombus assessed by OCT was observed in either group. No significant differences in OCT characteristics or measurements of neointima were seen between groups at 9- or 18-month follow-ups. Neointimal volume increased from 9 to 18 months in both groups, with a similar degree of neointimal proliferation in both groups (shorter DAPT group, 0.23 ± 0.29 mm3/mm; longer DAPT group, 0.19 ± 0.27 mm3/mm; P = 0.56). In conclusion, interrupting DAPT 9 months after second-generation DES implantation did not affect the development of in-stent thrombus, neointimal proliferation or stent strut coverage at 18-month follow-up compared with continuing DAPT.

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

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