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Ohashi H, Mizukami T, Sonck J, Boussiet F, Ko B, Nørgaard BL, Mæng M, Jensen JM, Sakai K, Ando H, Amano T, Amabile N, Ali Z, De Bruyne B, Koo B, Otake H, Collet C. Intravascular Imaging Findings After PCI in Patients With Focal and Diffuse Coronary Artery Disease. J Am Heart Assoc 2024; 13:e032605. [PMID: 38390822 PMCID: PMC10944036 DOI: 10.1161/jaha.123.032605] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/10/2023] [Accepted: 01/17/2024] [Indexed: 02/24/2024]
Abstract
BACKGROUND Following percutaneous coronary intervention (PCI), optical coherence tomography provides prognosis information. The pullback pressure gradient is a novel index that discriminates focal from diffuse coronary artery disease based on fractional flow reserve pullbacks. We sought to investigate the association between coronary artery disease patterns, defined by coronary physiology, and optical coherence tomography after stent implantation in stable patients undergoing PCI. METHODS AND RESULTS This multicenter, prospective, single-arm study was conducted in 5 countries (NCT03782688). Subjects underwent motorized fractional flow reserve pullbacks evaluation followed by optical coherence tomography-guided PCI. Post-PCI optical coherence tomography minimum stent area, stent expansion, and the presence of suboptimal findings such as incomplete stent apposition, stent edge dissection, and irregular tissue protrusion were compared between patients with focal versus diffuse disease. Overall, 102 patients (105 vessels) were included. Fractional flow reserve before PCI was 0.65±0.14, pullback pressure gradient was 0.66±0.14, and post-PCI fractional flow reserve was 0.88±0.06. The mean minimum stent area was 5.69±1.99 mm2 and was significantly larger in vessels with focal disease (6.18±2.12 mm2 versus 5.19±1.72 mm2, P=0.01). After PCI, incomplete stent apposition, stent edge dissection, and irregular tissue protrusion were observed in 27.6%, 10.5%, and 51.4% of the cases, respectively. Vessels with focal disease at baseline had a lower prevalence of incomplete stent apposition (11.3% versus 44.2%, P=0.002) and more irregular tissue protrusion (69.8% versus 32.7%, P<0.001). CONCLUSIONS Baseline coronary pathophysiological patterns are associated with suboptimal imaging findings after PCI. Patients with focal disease had larger minimum stent area and a higher incidence of tissue protrusion, whereas stent malapposition was more frequent in patients with diffuse disease.
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Affiliation(s)
- Hirofumi Ohashi
- Cardiovascular Center AalstOLV ClinicAalstBelgium
- Department of CardiologyAichi Medical UniversityAichiJapan
| | - Takuya Mizukami
- Cardiovascular Center AalstOLV ClinicAalstBelgium
- Division of Clinical Pharmacology, Department of PharmacologyShowa UniversityTokyoJapan
- Department of Cardiovascular MedicineGifu Heart CenterGifuJapan
| | - Jeroen Sonck
- Cardiovascular Center AalstOLV ClinicAalstBelgium
| | - Frederic Boussiet
- Cardiovascular Center AalstOLV ClinicAalstBelgium
- Department of CardiologyToulouse University HospitalToulouseFrance
| | - Brian Ko
- Monash Cardiovascular Research CentreMonash University and Monash Heart, Monash HealthClaytonVictoriaAustralia
| | | | - Michael Mæng
- Department of CardiologyAarhus University HospitalAarhusDenmark
| | | | - Koshiro Sakai
- Cardiovascular Center AalstOLV ClinicAalstBelgium
- Department of Medicine, Division of CardiologyShowa University School of MedicineTokyoJapan
| | - Hirohiko Ando
- Department of CardiologyAichi Medical UniversityAichiJapan
| | - Tetsuya Amano
- Department of CardiologyAichi Medical UniversityAichiJapan
| | - Nicolas Amabile
- Department of CardiologyInstitut Mutualiste MontsourisParisFrance
| | - Ziad Ali
- DeMatteis Cardiovascular InstituteSt. Francis Hospital & Heart CenterRoslynNY
| | - Bernard De Bruyne
- Cardiovascular Center AalstOLV ClinicAalstBelgium
- Department of CardiologyLausanne University HospitalLausanneSwitzerland
| | - Bon‐Kwon Koo
- Department of Internal Medicine and Cardiovascular CenterSeoul National University HospitalSeoulSouth Korea
| | - Hiromasa Otake
- Division of Cardiovascular Medicine, Department of Internal MedicineKobe University Graduate School of MedicineKobeJapan
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Abouelnour AEI, Olschewski M, Makmur G, Ullrich H, Knorr M, Ahoopai M, Münzel T, Gori T. Six-months clinical and intracoronary imaging follow-up after reverse T and protrusion or double-kissing and crush stenting for the treatment of complex left main bifurcation lesions. Front Cardiovasc Med 2023; 10:1153652. [PMID: 37180808 PMCID: PMC10174439 DOI: 10.3389/fcvm.2023.1153652] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2023] [Accepted: 04/12/2023] [Indexed: 05/16/2023] Open
Abstract
Background There is a debate regarding the best stent strategy for unprotected distal left main (LM) bifurcation disease. Among two-stent techniques, double-kissing and crush (DKC) is favored in current guidelines but is complex and requires expertise. Reverse T and Protrusion (rTAP) was shown to be a comparable strategy regarding short-term efficacy and safety, but with reduced procedural complexity. Aim To compare rTAP vs. DKC by optical coherence tomography (OCT) on the intermediate term. Methods 52 consecutive patients with complex unprotected LM stenoses (Medina 0,1,1 or 1,1,1) were randomized to either DKC or rTAP and followed-up for a median of 189[180-263] days for clinical and OCT outcomes. Results At follow-up OCT showed similar change in the side branch (SB) ostial area (primary endpoint). The confluence polygon showed a higher percentage of malapposed stent struts in the rTAP group that did not reach statistical significance (rTAP: 9.7[4.4-18.3] % vs. DKC: 3[0.07-10.9] %; p = 0.064). It also showed a trend towards larger neointimal area relative to the stent area (DKC: 8.8 [6.9 to 13.4] % vs. rTAP: 6.5 [3.9 to 8.9] %; p = 0.07), and smaller luminal area (DKC: 9.54[8.09-11.07] mm2 vs. rTAP: 11.21[9.53-12.42] mm²; p = 0.09) in the DKC group. The minimum luminal area in the parent vessel distal to the bifurcation was significantly smaller in the DKC group (DKC: 4.64 [3.64 to 5.34] mm² vs. rTAP: 6.76 [5.20 to 7.29] mm²; p = 0.03). This segment also showed a trend for smaller stent areas (p = 0.05 to 0.09), and a bigger neointimal area relative to the stent area (DKC: 8.94 [5.43 to 10.5]% vs. rTAP: 4.75 [0.08 to 8.5]%; p = 0.06) in the DKC patients. The incidence of clinical events was comparably low in both groups. Conclusion At 6-months, OCT showed a similar change in the SB ostial area (primary endpoint) in rTAP compared to DKC. There was also a trend for smaller luminal areas in the confluence polygon and the distal parent vessel, and a larger neointimal area relative to the stent area, in DKC, along with a tendency for more malapposed stent struts in rTAP. Clinical Trial Registration https://clinicaltrials.gov/ct2/show/NCT03714750, identifier: NCT03714750.
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Affiliation(s)
- Amr EI Abouelnour
- University Medical Center Mainz, Department of Cardiology, Mainz, Germany and German Center for Cardiac and Vascular Research (DZHK), Standort Rhein-Main, Germany
- Department of Cardiovascular Medicine, Assiut University Heart Hospital, Assiut, Egypt
| | - Maximilian Olschewski
- University Medical Center Mainz, Department of Cardiology, Mainz, Germany and German Center for Cardiac and Vascular Research (DZHK), Standort Rhein-Main, Germany
| | - Giulio Makmur
- University Medical Center Mainz, Department of Cardiology, Mainz, Germany and German Center for Cardiac and Vascular Research (DZHK), Standort Rhein-Main, Germany
| | - Helen Ullrich
- University Medical Center Mainz, Department of Cardiology, Mainz, Germany and German Center for Cardiac and Vascular Research (DZHK), Standort Rhein-Main, Germany
| | - Maike Knorr
- University Medical Center Mainz, Department of Cardiology, Mainz, Germany and German Center for Cardiac and Vascular Research (DZHK), Standort Rhein-Main, Germany
| | - Majid Ahoopai
- University Medical Center Mainz, Department of Cardiology, Mainz, Germany and German Center for Cardiac and Vascular Research (DZHK), Standort Rhein-Main, Germany
| | - Thomas Münzel
- University Medical Center Mainz, Department of Cardiology, Mainz, Germany and German Center for Cardiac and Vascular Research (DZHK), Standort Rhein-Main, Germany
| | - Tommaso Gori
- University Medical Center Mainz, Department of Cardiology, Mainz, Germany and German Center for Cardiac and Vascular Research (DZHK), Standort Rhein-Main, Germany
- Correspondence: Tommaso Gori
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Abouelnour A, Gori T. Intravascular imaging in coronary stent restenosis: Prevention, characterization, and management. Front Cardiovasc Med 2022; 9:843734. [PMID: 36017094 PMCID: PMC9395642 DOI: 10.3389/fcvm.2022.843734] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/26/2021] [Accepted: 07/21/2022] [Indexed: 11/13/2022] Open
Abstract
Despite the introduction of drug-eluting stents to combat the neointimal hyperplasia that occurred after BMS implantation, in-stent restenosis is still encountered in a significant number of patients, particularly as increasingly complex lesions are tackled by percutaneous coronary intervention. Many biological and mechanical factors interplay to produce restenosis, some of which are avoidable. Intravascular imaging provided unique insights into various forms of stent-related mechanical issues that contribute to this phenomenon. From a practical perspective, intravascular imaging can therefore help to optimize the stenting procedure to avert these issues. Moreover, once the problem of restenosis eventuates, imaging can guide the management by tackling the underlying identified mechanism. Finally, it can be used to evaluate the re-intervention results. Nevertheless, with the emergence of different treatment options, more evidence is needed to define patient/lesion-specific characteristics that may help to tailor treatment selection in a way that improves clinical outcomes.
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Affiliation(s)
- Amr Abouelnour
- Zentrum für Kardiologie, Kardiologie I, Deutsches Zentrum für Herz und Kreislauf Forschung, University Medical Center Mainz, Mainz, Germany
- Department of Cardiovascular Medicine, Cardiovascular Institute, Assiut University, Assiut, Egypt
| | - Tommaso Gori
- Zentrum für Kardiologie, Kardiologie I, Deutsches Zentrum für Herz und Kreislauf Forschung, University Medical Center Mainz, Mainz, Germany
- *Correspondence: Tommaso Gori,
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Alasnag M, Ahmed W, Al-Bawardy R, Shammeri OA, Biswas S, Johnson TW. Optimising PCI by Intracoronary Image-guidance. Front Cardiovasc Med 2022; 9:878801. [PMID: 35647055 PMCID: PMC9136172 DOI: 10.3389/fcvm.2022.878801] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2022] [Accepted: 04/11/2022] [Indexed: 11/13/2022] Open
Abstract
Evidence to support the use of intracoronary imaging (ICI) in guiding percutaneous coronary intervention (PCI) is growing, with observational and randomized controlled trials demonstrating a benefit in acute procedural and clinical outcomes. ICI provides an opportunity to guide PCI, detailing the nature of the coronary disease, potentially influencing lesion preparation and stent selection. Following stent deployment, ICI offers a detailed assessment of lesion coverage, associated vessel trauma and stent expansion. Consensus statements have emphasized the role of ICI and detailed the parameters of stent optimization. However, intracoronary imaging is not adopted widely yet. Significant global differences in the uptake of ICI have been reported, with the vast majority of PCI being angiographically-guided. The three major barriers to the implementation of ICI include, in order of impact, prohibitive cost, prolongation of procedure time and local regulatory issues for use. However, it is our belief that a lack of education and the associated challenges of ICI interpretation provide the greatest barrier to adoption. We hope that this review of the role of ICI in PCI optimization will provide a platform for PCI operators to gain confidence in the utilization of ICI to enhance outcomes for their patients.
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Affiliation(s)
- Mirvat Alasnag
- Cardiac Center, King Fahd Armed Forces Hospital, Jeddah, Saudi Arabia
- *Correspondence: Mirvat Alasnag
| | - Waqar Ahmed
- Cardiac Center, King Fahd Armed Forces Hospital, Jeddah, Saudi Arabia
| | - Rasha Al-Bawardy
- King Faisal Cardiac Center, King Abdulaziz Medical City, Ministry of National Guard Health Affairs, King Saud bin Abdulaziz University for Health Science, Jeddah, Saudi Arabia
| | | | - Sinjini Biswas
- Bristol Heart Institute, Translational Health Science, University of Bristol, Bristol, United Kingdom
| | - Thomas W. Johnson
- Bristol Heart Institute, Translational Health Science, University of Bristol, Bristol, United Kingdom
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Kyodo A, Okura H, Okamura A, Iwai S, Kamon D, Hashimoto Y, Ueda T, Soeda T, Watanabe M, Saito Y. Incidence and characteristics of incomplete stent apposition in calcified lesions: An optical coherence tomography study. CARDIOVASCULAR REVASCULARIZATION MEDICINE 2022; 41:55-60. [PMID: 34998648 DOI: 10.1016/j.carrev.2021.12.032] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2021] [Revised: 12/28/2021] [Accepted: 12/29/2021] [Indexed: 12/28/2022]
Abstract
BACKGROUND Persistent or late acquired incomplete stent apposition (ISA) may be associated with late or very late stent thrombosis following drug-eluting stent implantation. Presence of calcium at the target lesion may increase the risk of ISA even after rotational atherectomy (RA) followed by stenting with high pressure balloon inflation. The aim of this study is to examine the incidence and characteristics of ISA in heavily calcified lesions. METHODS A total of 52 heavily calcified coronary artery lesions requiring RA plus stenting were selected and studied. After successful ablation followed by stent implantation, optical coherence tomography (OCT) was performed to assess stent expansion and apposition. Presence or absence of ISA was examined and maximal stent strut to vessel wall distance (max SV distance) was measured. In lesions with repeated OCT at follow-up, serial changes in ISA were investigated. RESULTS ISA was documented in 51 of 52 (98%) lesions. Mean max SV distance was 713 ± 371 μm. In lesions with serial OCT images (n = 11), max SV distance decreased significantly (692.1 ± 420.2 to 462.5 ± 387.0 μm, P < 0.01) but persisted in all but 2 lesions (82%). CONCLUSIONS ISA is frequently documented in heavily calcified lesions requiring RA. Significant ISA still persisted with minimal improvement in SV distance at follow-up. Prognostic impact of the persistent ISA in such calcified lesions needs further investigations.
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Affiliation(s)
- Atsushi Kyodo
- Department of Cardiovascular Medicine, Nara Medical University, Kashihara, Japan
| | - Hiroyuki Okura
- Department of Cardiovascular Medicine, Nara Medical University, Kashihara, Japan; Department of Cardiology, Gifu University Graduate School of Medicine, Gifu, Japan.
| | - Akihiko Okamura
- Department of Cardiovascular Medicine, Nara Medical University, Kashihara, Japan
| | - Saki Iwai
- Department of Cardiovascular Medicine, Nara Medical University, Kashihara, Japan
| | - Daisuke Kamon
- Department of Cardiovascular Medicine, Nara Medical University, Kashihara, Japan
| | - Yukihiro Hashimoto
- Department of Cardiovascular Medicine, Nara Medical University, Kashihara, Japan
| | - Tomoya Ueda
- Department of Cardiovascular Medicine, Nara Medical University, Kashihara, Japan
| | - Tsunenari Soeda
- Department of Cardiovascular Medicine, Nara Medical University, Kashihara, Japan
| | - Makoto Watanabe
- Department of Cardiovascular Medicine, Nara Medical University, Kashihara, Japan
| | - Yoshihiko Saito
- Department of Cardiovascular Medicine, Nara Medical University, Kashihara, Japan
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Ando H, Nakano Y, Sawada H, Ohashi H, Takashima H, Suzuki A, Sakurai S, Amano T. Diagnostic Performance of High-Resolution Intravascular Ultrasound for Abnormal Post-Stent Findings After Stent Implantation - A Comparison Study Between High-Resolution Intravascular Ultrasound and Optical Coherence Tomography. Circ J 2021; 85:883-890. [PMID: 33551396 DOI: 10.1253/circj.cj-20-0817] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
BACKGROUND High-resolution intravascular ultrasound (HR-IVUS) is the most recently developed IVUS technology, which allows the detailed assessment of intravascular structures. The aim of this study was to evaluate the diagnostic performance of HR-IVUS in the detection of abnormal post-stent findings.Methods and Results:Patients with acute coronary syndrome underwent both HR-IVUS and optical coherence tomography (OCT) for post-stent evaluations. Quantitative measurements for stented segments and qualitative assessments for abnormal post-stent findings (stent edge dissection, intrastent tissue protrusion, and incomplete stent apposition [ISA]) were performed. Forty-seven patients underwent both HR-IVUS and OCT after stent implantation. HR-IVUS identified a larger minimal lumen area and a larger minimal lumen diameter than OCT (6.66±1.98 mm2vs. 5.61±1.79 mm2and 2.87±0.42 mm vs. 2.63±0.43 mm, respectively; both P<0.001). The sensitivity of HR-IVUS for the identification of stent edge dissection, intrastent tissue protrusion, and ISA were 20.0%, 48.9%, and 27.2%, respectively. CONCLUSIONS In terms of post-stent evaluation, the diagnostic performance of HR-IVUS remains insufficient. Abnormal post-stent findings might be underestimated when performing HR-IVUS due to its low sensitivity.
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Kyodo A, Watanabe M, Okamura A, Iwai S, Sakagami A, Nogi K, Kamon D, Hashimoto Y, Ueda T, Soeda T, Okura H, Saito Y. Post-Stent Optical Coherence Tomography Findings at Index Percutaneous Coronary Intervention - Characteristics Related to Subsequent Stent Thrombosis. Circ J 2021; 85:857-866. [PMID: 33504743 DOI: 10.1253/circj.cj-20-0759] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
BACKGROUND The association between unfavorable post-stent optical coherence tomography (OCT) findings and subsequent stent thrombosis (ST) remains unclear. This study investigated the ST-related characteristics of post-stent OCT findings at index percutaneous coronary intervention (PCI).Methods and Results:Fifteen patients with ST onset after OCT-guided PCI (ST group) were retrospectively enrolled. Post-stent OCT findings in the ST group were compared with those in 70 consecutive patients (reference group) without acute coronary syndrome onset for at least 5 years after OCT-guided PCI. The incidence of acute myocardial infarction (AMI) was higher in the ST than reference group (60.0% vs. 17.1%, respectively; P=0.0005). The incidence of incomplete stent apposition (93.3% vs. 55.7%; P=0.0064), irregular protrusion (IP; 93.3% vs. 62.8%; P=0.0214), and thrombus (93.3% vs. 51.4%; P=0.0028) was significantly higher in the ST than reference group. The maximum median (interquartile range) IP arc was significantly larger in the ST than reference group (265° [217°-360°] vs. 128° [81.4°-212°], respectively; P<0.0001). In AMI patients, the incidence of a maximum IP arc >180° was significantly higher in the ST than reference group (100% vs. 58.3%, respectively; P=0.0265). CONCLUSIONS IP with a large arc was a significant feature on post-stent OCT in patients with ST.
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Affiliation(s)
- Atsushi Kyodo
- Department of Cardiovascular Medicine, Nara Medical University
| | - Makoto Watanabe
- Department of Cardiovascular Medicine, Nara Medical University
| | - Akihiko Okamura
- Department of Cardiovascular Medicine, Nara Medical University
| | - Saki Iwai
- Department of Cardiovascular Medicine, Nara Medical University
| | - Azusa Sakagami
- Department of Cardiovascular Medicine, Nara Medical University
| | - Kazutaka Nogi
- Department of Cardiovascular Medicine, Nara Medical University
| | - Daisuke Kamon
- Department of Cardiovascular Medicine, Nara Medical University
| | | | - Tomoya Ueda
- Department of Cardiovascular Medicine, Nara Medical University
| | - Tsunenari Soeda
- Department of Cardiovascular Medicine, Nara Medical University
| | - Hiroyuki Okura
- Department of Cardiology, Gifu University Graduate School of Medicine
| | - Yoshihiko Saito
- Department of Cardiovascular Medicine, Nara Medical University
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Clinical Implications of Post-Stent Optical Coherence Tomographic Findings: Severe Malapposition and Cardiac Events. JACC Cardiovasc Imaging 2021; 15:126-137. [PMID: 34023255 DOI: 10.1016/j.jcmg.2021.03.008] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/13/2020] [Revised: 02/01/2021] [Accepted: 03/03/2021] [Indexed: 11/20/2022]
Abstract
OBJECTIVES This study sought to evaluate the impact of post-stent optical coherence tomography (OCT) findings, including severe malapposition, on long-term clinical outcomes. BACKGROUND Suboptimal OCT findings following percutaneous coronary intervention (PCI) are highly prevalent; however, their clinical implications remain controversial. METHODS Of the patients registered in the Yonsei OCT registry, a total of 1,290 patients with 1,348 lesions, who underwent OCT immediately post-stenting, were consecutively enrolled for this study. All patients underwent implantation of drug-eluting stents. Post-stent OCT findings were assessed to identify predictors of device-oriented clinical endpoints (DoCE), including cardiac death, target vessel-related myocardial infarction (MI) or stent thrombosis, and target lesion revascularization (TLR). Significant malapposition criteria associated with major safety events (MSE) were also investigated, such as cardiac death, target vessel-related MI, or stent thrombosis. RESULTS The median follow-up period was 43.0 months (interquartile range [IQR] 21.4 to 56.0 months). The incidence rates of stent edge dissection, tissue prolapse, thrombus, and malapposition after intervention were not associated with occurrence of DoCE. However, patients with significant malapposition (total malapposition volume [TMV] ≥7.0 mm3] exhibited more frequent MSE. A smaller minimal stent area (MSA) was identified as an independent predictor for DoCE (hazard ratio [HR]: 1.20 [95% confidence interval [CI]: 1.00 to 1.43]; p = 0.045). Malapposition with TMV ≥7.0 mm3 was found to be an independent predictor of MSE (HR: 6.12 [95% CI: 1.88 to 19.95]; p = 0.003). Follow-up OCT at 3, 6, or 9 months after PCI showed that post-stent TMV ≥7.0 mm3 was related to a greater occurrence of late malapposition and uncovered struts. CONCLUSIONS Although most suboptimal OCT findings were not associated with clinical outcomes, a smaller MSA was associated with DoCE, driven mainly by TLR, and significant malapposition with TMV ≥7.0 mm3 was associated with more MSE after PCI. (Yonsei OCT [Optical Coherence Tomography] Registry for Evaluation of Efficacy and Safety of Coronary Stenting; Yonsei OCT registry; NCT02099162).
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Roland R, Veselka J. Optical Coherence Tomography of the Coronary Arteries. Int J Angiol 2021; 30:29-39. [PMID: 34045841 DOI: 10.1055/s-0041-1724019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022] Open
Abstract
Intravascular imaging, particularly optical coherence tomography, has brought significant improvement in diagnostic and therapeutical approaches to coronary artery disease and has offered superior high-resolution visualization of coronary arteries. The ability to obtain images of intramural and transmural coronary structures allows the study of the process of atherosclerosis, effect of therapies, mechanism of acute coronary syndrome and stent failure, and performance of new devices and enables the interventional cardiologist to optimize the effect of percutaneous coronary intervention. In this review, we provide the summary of the latest published data on clinical use of optical coherence tomography as well as practical algorithm for optical coherence tomography-guided percutaneous coronary intervention for daily interventional practice.
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Affiliation(s)
- Robert Roland
- Department of Cardiology, Motol University Hospital, Charles University, Prague, Czech Republic
| | - Josef Veselka
- Department of Cardiology, Motol University Hospital, Charles University, Prague, Czech Republic
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Optical coherence tomography-guided percutaneous coronary intervention: a review of current clinical applications. Cardiovasc Interv Ther 2021; 36:169-177. [PMID: 33454867 DOI: 10.1007/s12928-020-00745-4] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2020] [Accepted: 12/08/2020] [Indexed: 12/28/2022]
Abstract
Optical coherence tomography (OCT) is an emerging high-resolution intravascular imaging modality that can provide physicians with critical information, thereby enabling precise characterization of plaque morphology and luminal geometry and facilitating pre-intervention lesion assessment. As OCT has a higher sensitivity for lipid-rich plaque characterization than intravascular ultrasound, vulnerable plaque detection by OCT has thus been investigated. By evaluating both the calcium thickness and arc, OCT can be the ideal method for determining both the indication and endpoint of rotational atherectomy for calcified lesions prior to stent implantation. OCT has become applicable for the optimization of stent implantation with immediate and semi-automatic quantification of stent apposition and expansion to achieve potentially better clinical outcomes. In bifurcation lesions, OCT allows the visualization of the stent-link location overhanging the side-branch ostium and the guidewire recrossing point prior to the final kissing balloon inflation through three-dimensional reconstructed OCT images, providing us with deep insights into the mechanical optimization of stent struts. Furthermore, recent studies have reported several OCT-derived predictors of adverse clinical events. Important limitations of OCT, including the excessive contrast volume needed and observation of aorto-ostial lesions, may partially be overcome through the use of low-molecular-weight dextran and a guide extension catheter. The clinical applications of OCT have been expanding, and evidence on its clinical utility has been accumulating.
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Temporal changes of incomplete stent apposition during early phase after everolimus-eluting stent implantation: serial optical coherence tomography analyses at 2-week and 4-month. Int J Cardiovasc Imaging 2020; 37:411-417. [PMID: 32926310 DOI: 10.1007/s10554-020-02023-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/18/2020] [Accepted: 09/09/2020] [Indexed: 10/23/2022]
Abstract
The healing process of acute incomplete stent apposition (ISA) in the early phase after stent implantation has not been well understood. We evaluated the temporal changes of ISA during the early phase after everolimus-eluting stent (EES) implantation using serial optical coherence tomography (OCT) analyses. Serial OCT examinations were performed immediately post-stenting and 2-week and 4-month after EES implantation for patients with ST-segment elevation myocardial infarction. At the most proximal cross-section of the implanted stent, the prevalence of ISA and maximum ISA distance were serially evaluated. In 45 patients with ST-segment elevation myocardial infarction, serial OCT analyses at 2-week and 4-month were performed. The prevalence of ISA gradually decreased over time, being 53.3% at baseline, 37.8% at 2-week follow-up, and 11.1% at 4-month follow-up (P < 0.001). The maximum ISA distance also decreased over time (P < 0.001). A receiver-operating curve analysis found that the optimal cut-off values of the baseline ISA distance for predicting persistent ISA at 2-week follow-up and 4-month follow-up were > 140 µm and > 215 µm, respectively. The baseline ISA distance was closely associated with the healing of ISA in the early phase after EES implantation. Maintaining the minimum ISA distance at post-stenting facilitates early phase healing of acute ISA.
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Lee SY, Mintz GS, Kim JS, Kim BK, Jang Y, Hong MK. Long-term Clinical Outcomes of Drug-Eluting Stent Malapposition. Korean Circ J 2020; 50:880-889. [PMID: 32812407 PMCID: PMC7515765 DOI: 10.4070/kcj.2020.0198] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2020] [Revised: 06/12/2020] [Accepted: 07/14/2020] [Indexed: 11/11/2022] Open
Abstract
Previous pathologic, intravascular imaging, and clinical studies have investigated the association between adverse cardiac events and stent malapposition, including acute stent malapposition (ASM, that is detected at index procedure) and late stent malapposition (LSM, that is detected during follow-up) that can be further classified into late-persistent stent malapposition (LPSM, ASM that remains at follow-up) or late-acquired stent malapposition (LASM, newly developed stent malapposition at follow-up that was not present immediately after index stent implantation). ASM has not been associated with adverse cardiac events compared with non-ASM, even in lesions with large-sized malapposition. The clinical outcomes of LSM may depend on its subtype. The recent intravascular ultrasound studies with long-term follow-up have consistently demonstrated that LASM steadily increased the risk of thrombotic events in patients with first-generation drug-eluting stents (DESs). This association has not yet been identified in LPSM. Accordingly, it is reasonable that approaches to stent malapposition should be based on its relationship with clinical outcomes. ASM may be tolerable after successful stent implantation, whereas prolonged anti-thrombotic medications and/or percutaneous interventions to modify LASM may be considered in selected patients with first-generation DESs. However, these treatments are still questionable due to lack of firm evidences.
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Affiliation(s)
- Seung Yul Lee
- Regional Cardiocerebrovascular Center, Wonkwang University Hospital, Iksan, Korea
| | - Gary S Mintz
- Cardiovascular Research Foundation, New York, NY, USA
| | - Jung Sun Kim
- Division of Cardiology, Severance Cardiovascular Hospital, Yonsei University Health System, Seoul, Korea
| | - Byeong Keuk Kim
- Division of Cardiology, Severance Cardiovascular Hospital, Yonsei University Health System, Seoul, Korea
| | - Yangsoo Jang
- Division of Cardiology, Severance Cardiovascular Hospital, Yonsei University Health System, Seoul, Korea
| | - Myeong Ki Hong
- Division of Cardiology, Severance Cardiovascular Hospital, Yonsei University Health System, Seoul, Korea.
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13
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Matsuda Y, Ashikaga T, Sasaoka T, Hatano Y, Umemoto T, Lee T, Yonetsu T, Maejima Y, Sasano T. Comparison of Neointimal Response between Durable-Polymer Everolimus-Eluting Stent and Bioabsorbable-Polymer Everolimus-Eluting Stent for Severely Calcified Lesions Requiring Rotational Atherectomy. Int Heart J 2020; 61:665-672. [PMID: 32684594 DOI: 10.1536/ihj.19-648] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
Clinical outcomes after percutaneous coronary intervention (PCI) for severely calcified lesions remain poor. The purpose of this study was to investigate the neointimal response after everolimus-eluting stents (EES) for severely calcified lesions treated with rotational atherectomy (RA) using optical coherence tomography (OCT).We retrospectively analyzed 34 lesions in which PCI was performed with EES deployment following RA and OCT was performed immediately after PCI and at follow-up (nine months). The EES was either durable-polymer (DP) EES (22 lesions) or bioabsorbable polymer (BP) -EES (12 lesions). Strut coverage and malapposition were evaluated at 1-mm intervals of cross-section (CS) by serial OCT analysis. Malapposed strut was defined as having the distance from luminal border > 100 μm.A total of 11,823 struts immediately after PCI and 11,720 struts at follow-up were analyzed. Immediately after PCI, the strut-level analysis showed no significant differences in the percentage of malapposed struts between the DP-EES group and the BP-EES group. At follow-up, the BP-EES group showed a more prevalent covered strut compared with the DP-EES group (strut-level analysis: 95% versus 97%, P = 0.045; CS-level analysis: 97% versus 100%, P < 0.01; lesion-level analysis: 27% versus 83%, P < 0.01, respectively).In severely calcified lesions requiring RA, the BP-EES group achieved better neointimal coverage than the DP-EES group at nine months. Additional prospective studies are needed.
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Affiliation(s)
- Yuji Matsuda
- Department of Cardiovascular Medicine, Graduate School of Medical and Dental Science, Tokyo Medical and Dental University
| | - Takashi Ashikaga
- Department of Cardiology, Japanese Red Cross Musashino Hospital.,Department of Cardiovascular Medicine, Faculty of Medicine, Tokyo Medical and Dental University
| | - Taro Sasaoka
- Department of Cardiovascular Medicine, Faculty of Medicine, Tokyo Medical and Dental University
| | - Yu Hatano
- Department of Cardiovascular Medicine, Faculty of Medicine, Tokyo Medical and Dental University
| | - Tomoyuki Umemoto
- Department of Cardiovascular Medicine, Faculty of Medicine, Tokyo Medical and Dental University
| | - Tetsumin Lee
- Department of Cardiovascular Medicine, Faculty of Medicine, Tokyo Medical and Dental University
| | - Taishi Yonetsu
- Department of Cardiovascular Medicine, Faculty of Medicine, Tokyo Medical and Dental University
| | - Yasuhiro Maejima
- Department of Cardiovascular Medicine, Faculty of Medicine, Tokyo Medical and Dental University
| | - Tetsuo Sasano
- Department of Cardiovascular Medicine, Graduate School of Medical and Dental Science, Tokyo Medical and Dental University.,Department of Cardiovascular Medicine, Faculty of Medicine, Tokyo Medical and Dental University
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14
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Nguyen P, Seto A. Contemporary practices using intravascular imaging guidance with IVUS or OCT to optimize percutaneous coronary intervention. Expert Rev Cardiovasc Ther 2020; 18:103-115. [PMID: 32077345 DOI: 10.1080/14779072.2020.1732207] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
Introduction: Angiography is routinely used to perform percutaneous coronary intervention (PCI). However, angiography has many limitations that prevent accurate assessment of coronary lesions. The development and evolution of intravascular imaging have offset the limitations of angiography. Overwhelming evidence supports intravascular imaging guidance to optimize PCI results and studies have shown that it is associated with better outcomes. Intravascular ultrasound (IVUS) and optical coherence tomography (OCT) are the most commonly used modalities and both have far greater spatial resolution compared with angiography. There are advantages and disadvantages to both IVUS and OCT, and the optimal modality will depend on patient factors and indications.Areas covered: This review will summarize clinical evidence and current practices in the use of intravascular imaging in PCI. Literature review from year 2000-2019 was completed via PubMed search using keywords.Expert commentary: Intravascular imaging is an essential tool in PCI that has outcome implications, but it is still underutilized. Proper image acquisition, accurate interpretation, and correct decision-making are needed for patients to benefit from imaging-guided PCI. Training and education are essential in successful utilization of imaging technology. High-definition IVUS is likely to gain favor as there is improved image resolution without the use of contrast.
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Affiliation(s)
- Peter Nguyen
- Cardiology, University of California, Irvine, CA, USA.,Cardiology, VA Long Beach Health Care System, Long Beach, CA, USA
| | - Arnold Seto
- Cardiology, University of California, Irvine, CA, USA.,Cardiology, VA Long Beach Health Care System, Long Beach, CA, USA
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15
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Kočka V, Toušek P, Kozel M, Buono A, Hajšl M, Lisa L, Buděšínský T, Malý M, Widimský P. Bioresorbable scaffold implantation in STEMI patients: 5 years imaging subanalysis of PRAGUE-19 study. J Transl Med 2020; 18:33. [PMID: 32000796 PMCID: PMC6993315 DOI: 10.1186/s12967-020-02230-1] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2019] [Accepted: 01/14/2020] [Indexed: 11/10/2022] Open
Abstract
Background Bioresorbable scaffold (BRS) Absorb™ clinical use has been stopped due to higher rate of device thrombosis. Scaffold struts persist longer than 2 years in the vessel wall. Second generation devices are being developed. This study evaluates long-term invasive imaging in STEMI patients. Methods PRAGUE-19 study is an academic study enrolling consecutive STEMI patients with intention to implant Absorb™ BRS. A total of 83 STEMI patients between December 2012 and March 2014 fulfilled entry criteria. Coronary angiography and optical coherence tomography at 5 year follow-up was performed in 25 patients. Results Primary combined clinical endpoint (death, myocardial infarction or target vessel revascularization) occurred in 12.6% during the five-year follow-up with overall mortality 6.3%. Definite scaffold thrombosis occurred in 2 patients in the early phase after BRS implantation. Quantitative coronary angiography after 5 years demonstrated low late lumen loss of 0.11 ± 0.35 mm with binary restenosis rate of 0%. Optical coherence tomography demonstrated complete resorption of scaffold struts and mean lumen diameter of 3.25 ± 0.30 and 3.22 ± 0.49 (P = 0.73) at baseline and after 5 years, respectively. Three patients developed small coronary artery aneurysm in the treated segment. Conclusion Invasive imaging results 5 years after BRS implantation in STEMI showed complete resorption of scaffold struts and stable lumen vessel diameter. Trial registration ISRCTN43696201 (retrospectivelly registred, June 7th, 2019). https://www.isrctn.com/ISRCTN43696201.
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Affiliation(s)
- Viktor Kočka
- Cardiocenter, Third Faculty of Medicine, Charles University and University Hospital Kralovské Vinohrady, Šrobárova 50, Prague 10, 100 34, Czech Republic
| | - Petr Toušek
- Cardiocenter, Third Faculty of Medicine, Charles University and University Hospital Kralovské Vinohrady, Šrobárova 50, Prague 10, 100 34, Czech Republic.
| | - Martin Kozel
- Cardiocenter, Third Faculty of Medicine, Charles University and University Hospital Kralovské Vinohrady, Šrobárova 50, Prague 10, 100 34, Czech Republic
| | - Andrea Buono
- Department of Cardiology, Niguarda Ca' Granda Hospital, Milan, Italy
| | - Martin Hajšl
- Cardiovascular Center, First Faculty of Medicine, Charles University and Central Military Hospital Prague, Prague, Czech Republic
| | - Libor Lisa
- Cardiocenter, Third Faculty of Medicine, Charles University and University Hospital Kralovské Vinohrady, Šrobárova 50, Prague 10, 100 34, Czech Republic
| | - Tomáš Buděšínský
- Cardiocenter, Third Faculty of Medicine, Charles University and University Hospital Kralovské Vinohrady, Šrobárova 50, Prague 10, 100 34, Czech Republic
| | - Martin Malý
- Cardiovascular Center, First Faculty of Medicine, Charles University and Central Military Hospital Prague, Prague, Czech Republic
| | - Petr Widimský
- Cardiocenter, Third Faculty of Medicine, Charles University and University Hospital Kralovské Vinohrady, Šrobárova 50, Prague 10, 100 34, Czech Republic
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16
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Oda H, Itoh T, Sasaki W, Uchimura Y, Taguchi Y, Kaneko K, Sakamoto T, Goto I, Sakuma M, Ishida M, Kikuchi T, Terashita D, Otake H, Morino Y, Shinke T. Cut-off value of strut-vessel distance for the resolution of acute incomplete stent apposition in the early phase using serial optical coherence tomography after cobalt-chromium everolimus-eluting stent implantation. J Cardiol 2020; 75:641-647. [PMID: 31924410 DOI: 10.1016/j.jjcc.2019.12.006] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/06/2019] [Revised: 11/29/2019] [Accepted: 12/04/2019] [Indexed: 11/16/2022]
Abstract
OBJECTIVE The purpose of this study was to identify a cut-off value to predict the resolution of incomplete-stent-apposition (ISA) after cobalt-chromium everolimus-eluting stent (CoCr-EES) implantation at early follow-up. BACKGROUND To date, appropriate stent apposition at the acute period using intracoronary imaging has been recommended because persistent ISA is considered to be a risk factor for stent thrombosis. We examined the indices for resolving acute ISA. In particular, we determined the cut-off value for strut vessel distance (SV-distance) as visualized by optical coherence tomography (OCT) at 8 months after CoCr-EES implantation. However, the cut-off value of SV-distance for the earlier resolution of ISA is unclear. METHODS A total of 95 cases and 103 stents were registered in the MECHANISM Elective substudy. The SV-distance was measured at the deepest site of the target malapposition and every 1 mm from the proximal edge to the distal edge of the mal-apposed area using OCT. Cut-off values for ISA resolution at 1 and 3 months were estimated by SV-distance using receiver operating characteristic analysis. RESULTS The total number of analyzed struts was 14,418 at the 1-month follow-up and 11,986 at the 3-month follow-up. The optimal SV-distance cut-off values just after stent implantation to predict ISA resolution were 185 µm at the 1-month follow-up and 195 μm at the 3-month follow-up. CONCLUSION For resolution of ISA, SV-distance cut-off values of 185 µm at 1 month postimplantation and 195 μm at 3 months postimplantation can be used as the index of endpoint of the percutaneous coronary intervention.
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Affiliation(s)
- Hideto Oda
- Division of Cardiology, Department of Internal Medicine, Memorial Heart Center, Iwate Medical University, Morioka-city, Iwate, Japan
| | - Tomonori Itoh
- Division of Cardiology, Department of Internal Medicine, Memorial Heart Center, Iwate Medical University, Morioka-city, Iwate, Japan.
| | - Wataru Sasaki
- Division of Cardiology, Department of Internal Medicine, Memorial Heart Center, Iwate Medical University, Morioka-city, Iwate, Japan
| | - Yohei Uchimura
- Division of Cardiology, Department of Internal Medicine, Memorial Heart Center, Iwate Medical University, Morioka-city, Iwate, Japan
| | - Yuya Taguchi
- Division of Cardiology, Department of Internal Medicine, Memorial Heart Center, Iwate Medical University, Morioka-city, Iwate, Japan
| | - Kyosuke Kaneko
- Division of Cardiology, Department of Internal Medicine, Memorial Heart Center, Iwate Medical University, Morioka-city, Iwate, Japan
| | - Tsubasa Sakamoto
- Division of Cardiology, Department of Internal Medicine, Memorial Heart Center, Iwate Medical University, Morioka-city, Iwate, Japan
| | - Iwao Goto
- Division of Cardiology, Department of Internal Medicine, Memorial Heart Center, Iwate Medical University, Morioka-city, Iwate, Japan
| | - Masafumi Sakuma
- Division of Cardiology, Department of Internal Medicine, Memorial Heart Center, Iwate Medical University, Morioka-city, Iwate, Japan
| | - Masaru Ishida
- Division of Cardiology, Department of Internal Medicine, Memorial Heart Center, Iwate Medical University, Morioka-city, Iwate, Japan
| | - Tatsuo Kikuchi
- Department of Cardiology, Edogawa Hospital, Edogawa-ku, Tokyo, Japan
| | - Daisuke Terashita
- Division of Cardiovascular Medicine, Department of Internal Medicine, Kitaharima Medical Center, Ono-city, Hyogo, Japan
| | - Hiromasa Otake
- Division of Cardiology, Department of Internal Medicine, Kobe University Graduate School of Medicine, Chuo-ku, Kobe-city, Japan
| | - Yoshihiro Morino
- Division of Cardiology, Department of Internal Medicine, Memorial Heart Center, Iwate Medical University, Morioka-city, Iwate, Japan
| | - Toshiro Shinke
- Division of Cardiovascular Medicine, Showa University School of Medicine, Sinagawa-ku, Kobe, Japan
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17
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Hong SJ, Park KH, Ahn CM, Kim JS, Kim BK, Ko YG, Choi D, Jang Y, Hong MK. Severe acute stent malapposition follow-up: 3-month and 12-month serial quantitative analyses by optical coherence tomography. Int J Cardiol 2020; 299:81-86. [DOI: 10.1016/j.ijcard.2019.06.075] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/04/2019] [Revised: 06/11/2019] [Accepted: 06/27/2019] [Indexed: 11/26/2022]
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18
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Uchimura Y, Itoh T, Oda H, Taguchi Y, Sasaki W, Kaneko K, Sakamoto T, Goto I, Sakuma M, Ishida M, Kikuchi T, Terashita D, Otake H, Morino Y, Shinke T. Cut-off value of mal-apposition volume and depth for resolution at early phase of acute incomplete stent apposition after CoCr-EES implantation. Int J Cardiovasc Imaging 2019; 35:1979-1987. [PMID: 31256285 DOI: 10.1007/s10554-019-01657-y] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/12/2019] [Accepted: 06/21/2019] [Indexed: 11/24/2022]
Abstract
The purpose of this study was to clarify a cut-off value for acute incomplete stent apposition (ISA) volume and maximum-depth to predict ISA resolution at 1- and 3-month follow-up in patients treated with cobalt-chromium everolimus-eluting stents. In total, 95 cases and 103 stents were registered in the MECHANISM-Elective sub-study. Acute ISA-volume was measured by the trapezoid rule. ISA resolution of cut-off value at 1- and 3-month was estimated by ISA-volume and maximum-depth using receiver operatorating characteristic curve analysis. The total number of analysed acute ISAs was 202 in the 1-month group and 225 in the 3-month group. A total of 123 ISAs at 1-month and a total of 169 ISAs at 3-month had been resolved. The cut-off value of ISA resolution by ISA-volume was 0.169 mm3 at 1-month (AUC: 0.725, sensitivity: 72.2%, specificity: 61.0%) and 0.295 mm3 at 3-month (AUC: 0.757, sensitivity: 75.0%, specificity: 60.4%). The cut-off value of ISA resolution by ISA maximum-depth demonstrated was 0.285 mm at 1-month (area under curve (AUC): 0.789, sensitivity: 70.9%, specificity: 69.9%) and 0.305 mm at 3-month (AUC: 0.663, sensitivity: 60.7%, specificity: 66.9%). Incidence of ISA resolution was significantly lower in combination with cut-off values of ISA-volume and maximum-depth (33%, p < 0.001, at 1-month; 56%, p = 0.003, at 3-month). Combining the cut-off value of ISA-volume with the maximum-depth might be helpful to consider the endpoint of the PCI procedure.
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Affiliation(s)
- Yohei Uchimura
- Division of Cardiology, Department of Internal Medicine, Memorial Heart Center, Iwate Medical University, 19-1, Uchimaru, Morioka City, Iwate, Japan
| | - Tomonori Itoh
- Division of Cardiology, Department of Internal Medicine, Memorial Heart Center, Iwate Medical University, 19-1, Uchimaru, Morioka City, Iwate, Japan.
| | - Hideto Oda
- Division of Cardiology, Department of Internal Medicine, Memorial Heart Center, Iwate Medical University, 19-1, Uchimaru, Morioka City, Iwate, Japan
| | - Yuya Taguchi
- Division of Cardiology, Department of Internal Medicine, Memorial Heart Center, Iwate Medical University, 19-1, Uchimaru, Morioka City, Iwate, Japan
| | - Wataru Sasaki
- Division of Cardiology, Department of Internal Medicine, Memorial Heart Center, Iwate Medical University, 19-1, Uchimaru, Morioka City, Iwate, Japan
| | - Kyosuke Kaneko
- Division of Cardiology, Department of Internal Medicine, Memorial Heart Center, Iwate Medical University, 19-1, Uchimaru, Morioka City, Iwate, Japan
| | - Tsubasa Sakamoto
- Division of Cardiology, Department of Internal Medicine, Memorial Heart Center, Iwate Medical University, 19-1, Uchimaru, Morioka City, Iwate, Japan
| | - Iwao Goto
- Division of Cardiology, Department of Internal Medicine, Memorial Heart Center, Iwate Medical University, 19-1, Uchimaru, Morioka City, Iwate, Japan
| | - Masafumi Sakuma
- Division of Cardiology, Department of Internal Medicine, Memorial Heart Center, Iwate Medical University, 19-1, Uchimaru, Morioka City, Iwate, Japan
| | - Masaru Ishida
- Division of Cardiology, Department of Internal Medicine, Memorial Heart Center, Iwate Medical University, 19-1, Uchimaru, Morioka City, Iwate, Japan
| | - Tatsuo Kikuchi
- Department of Cardiology, Edogawa Hospital, 2-24-28, Higashikoiwa, Edogawa-ku, Tokyo, Japan
| | - Daisuke Terashita
- Division of Cardiovascular Medicine, Department of Internal Medicine, Kitaharima Medical Center, Ono, Japan
| | - Hiromasa Otake
- Division of Cardiology, Department of Internal Medicine, Graduate School of Medicine, Kobe University, 7-5-1, Kusunoki-cho, Chuo-ku, Kobe, Japan
| | - Yoshihiro Morino
- Division of Cardiology, Department of Internal Medicine, Memorial Heart Center, Iwate Medical University, 19-1, Uchimaru, Morioka City, Iwate, Japan
| | - Toshiro Shinke
- Division of Cardiovascular Medicine, Showa University School of Medicine, 1-5-8, Hatanodai, Shinagawa-ku, Tokyo, Japan
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19
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Lee SY, Im E, Hong SJ, Ahn CM, Kim JS, Kim BK, Ko YG, Choi D, Jang Y, Hong MK. Severe Acute Stent Malapposition After Drug-Eluting Stent Implantation: Effects on Long-Term Clinical Outcomes. J Am Heart Assoc 2019; 8:e012800. [PMID: 31237187 PMCID: PMC6662351 DOI: 10.1161/jaha.119.012800] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/03/2022]
Abstract
Background The effects of severe acute stent malapposition (ASM) after drug‐eluting stent implantation on long‐term clinical outcomes are not clearly understood. We evaluated long‐term clinical outcomes of severe ASM using optical coherence tomography. Methods and Results We pooled patient‐ and lesion‐level data from 6 randomized studies. Five studies investigated follow‐up drug‐eluting stent strut coverage and one investigated ASM. In this data set, a total of 436 patients with 444 lesions underwent postintervention optical coherence tomography examination and these data were included in the analysis. Severe ASM was defined as lesions with ≥400 μm of maximum malapposed distance or ≥1 mm of maximum malapposed length. Composite events (cardiac death, target lesion–related myocardial infarction, target lesion revascularization, and stent thrombosis) were compared between patients with and without severe ASM. The postintervention optical coherence tomography findings indicated that 62 (14.2%) patients had lesions with ≥400 μm of maximum malapposed distance and 186 (42.7%) patients had lesions with ≥1 mm of maximum malapposed length. The 5‐year clinical follow‐up was completed in 371 (86.1%) of the eligible 431 patients. The cumulative rate of composite events was similar among the patients in each group during 5‐year follow‐up: 3.3% in patients with ASM ≥400 μm of maximum malapposed distance versus 3.1% in those with no ASM or ASM <400 μm of maximum malapposed distance (P=0.89), and 1.2% in patients with ASM ≥1 mm of maximum malapposed length versus 4.6% in those with no ASM or ASM <1 mm of maximum malapposed length (P=0.06). Conclusions During the 5‐year follow‐up, ASM severity was not associated with long‐term clinical outcomes in patients treated with drug‐eluting stents.
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Affiliation(s)
- Seung-Yul Lee
- 1 Sanbon Hospital Wonkwang University College of Medicine Gunpo Korea
| | - Eui Im
- 2 Yongin Severance Hospital Yonsei University Health System Yongin Korea
| | - Sung-Jin Hong
- 3 Severance Cardiovascular Hospital Yonsei University Health System Seoul Korea
| | - Chul-Min Ahn
- 3 Severance Cardiovascular Hospital Yonsei University Health System Seoul Korea
| | - Jung-Sun Kim
- 3 Severance Cardiovascular Hospital Yonsei University Health System Seoul Korea
| | - Byeong-Keuk Kim
- 3 Severance Cardiovascular Hospital Yonsei University Health System Seoul Korea
| | - Young-Guk Ko
- 3 Severance Cardiovascular Hospital Yonsei University Health System Seoul Korea
| | - Donghoon Choi
- 3 Severance Cardiovascular Hospital Yonsei University Health System Seoul Korea
| | - Yangsoo Jang
- 3 Severance Cardiovascular Hospital Yonsei University Health System Seoul Korea
| | - Myeong-Ki Hong
- 3 Severance Cardiovascular Hospital Yonsei University Health System Seoul Korea
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20
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Early Follow-Up Optical Coherence Tomographic Findings of Significant Drug-Eluting Stent Malapposition. Circ Cardiovasc Interv 2018; 11:e007192. [DOI: 10.1161/circinterventions.118.007192] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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21
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Räber L, Mintz GS, Koskinas KC, Johnson TW, Holm NR, Onuma Y, Radu MD, Joner M, Yu B, Jia H, Meneveau N, de la Torre Hernandez JM, Escaned J, Hill J, Prati F, Colombo A, Di Mario C, Regar E, Capodanno D, Wijns W, Byrne RA, Guagliumi G. Clinical use of intracoronary imaging. Part 1: guidance and optimization of coronary interventions. An expert consensus document of the European Association of Percutaneous Cardiovascular Interventions. EUROINTERVENTION 2018; 14:656-677. [DOI: 10.4244/eijy18m06_01] [Citation(s) in RCA: 62] [Impact Index Per Article: 10.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
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22
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Ñato M, Gomez-Lara J, Romaguera R, Roura G, Ferreiro JL, Teruel L, Gracida M, Fuentes L, Vandeloo B, Gomez-Hospital JA, Cequier A. One-year optical coherence tomography findings in patients with late and very-late stent thrombosis treated with intravascular imaging guided percutaneous coronary intervention. Int J Cardiovasc Imaging 2018; 34:1511-1520. [DOI: 10.1007/s10554-018-1372-7] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/10/2018] [Accepted: 05/16/2018] [Indexed: 11/29/2022]
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23
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Räber L, Mintz GS, Koskinas KC, Johnson TW, Holm NR, Onuma Y, Radu MD, Joner M, Yu B, Jia H, Meneveau N, de la Torre Hernandez JM, Escaned J, Hill J, Prati F, Colombo A, di Mario C, Regar E, Capodanno D, Wijns W, Byrne RA, Guagliumi G, Alfonso F, Bhindi R, Ali Z, Carter R. Clinical use of intracoronary imaging. Part 1: guidance and optimization of coronary interventions. An expert consensus document of the European Association of Percutaneous Cardiovascular Interventions. Eur Heart J 2018; 39:3281-3300. [DOI: 10.1093/eurheartj/ehy285] [Citation(s) in RCA: 271] [Impact Index Per Article: 45.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/04/2018] [Accepted: 05/16/2018] [Indexed: 12/22/2022] Open
Affiliation(s)
- Lorenz Räber
- Department of Cardiology, Bern University Hospital, Bern, Switzerland
| | - Gary S Mintz
- Cardiovascular Research Foundation, New York, NY, USA
| | | | - Thomas W Johnson
- Bristol Heart Institute, University Hospitals Bristol NHSFT, Bristol, UK
| | - Niels R Holm
- Department of Cardiology, Aarhus University Hospital, Aarhus, Denmark
| | - Yoshinubo Onuma
- Department of Interventional Cardiology, Cardialysis, Thoraxcenter, Erasmus MC, Rotterdam, The Netherlands
| | - Maria D Radu
- The Heart Center, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
| | - Michael Joner
- Deutsches Herzzentrum München, Technische Universität München, Munich, Germany
- DZHK (German Center for Cardiovascular Research), partner site Munich Heart Alliance, Munich, Germany
| | - Bo Yu
- Department of Cardiology, 2nd Affiliated Hospital of Harbin Medical University, The Key Laboratory of Myocardial Ischemia, Chinese Ministry of Education, Harbin, China
| | - Haibo Jia
- Department of Cardiology, 2nd Affiliated Hospital of Harbin Medical University, The Key Laboratory of Myocardial Ischemia, Chinese Ministry of Education, Harbin, China
| | - Nicolas Meneveau
- Department of Cardiology, University Hospital Jean Minjoz, Besancon, France
- EA3920, University of Burgundy Franche-Comté, Besancon, France
| | | | - Javier Escaned
- Hospital Clinico San Carlos IDISSC and Universidad Complutense, Madrid, Spain
| | - Jonathan Hill
- Department of Cardiology, King’s College Hospital, London, UK
| | - Francesco Prati
- Department of Cardiology, San Giovanni Hospital, Rome, Italy & CLI Foundation, Rome, Italy
| | - Antonio Colombo
- Interventional Cardiology Unit, Cardio-Thoracic-Vascular Department, San Raffaele, Scientific Institute, Milan, Italy
| | - Carlo di Mario
- Structural Interventional Cardiology, Careggi University Hospital, Florence, Italy
| | - Evelyn Regar
- Department of Cardiovacular Surgery, Zürich University Hospita, Zürich, Switzerland
| | - Davide Capodanno
- Division of Cardiology, Cardio-Thoraco-Vascular and Transplant Department, CAST, Rodolico Hospital, AOU “Policlinico-Vittorio Emanuele”, University of Catania, Catania, Italy
| | - William Wijns
- The Lambe Institute for Translational Medicine and Curam, National University of Ireland Galway, Saolta University Healthcare Group, Galway, Ireland
| | - Robert A Byrne
- Deutsches Herzzentrum München, Technische Universität München, Munich, Germany
| | - Giulio Guagliumi
- Cardiovascular Department, Ospedale Papa Giovanni XXIII, Bergamo, Italy
| | - Fernando Alfonso
- Department of Cardiology Hospital Universitario de la Princesa, Madrid, Spain
| | - Ravinay Bhindi
- Royal North Shore Hospital, The University of Sydney, Sydney, Australia
| | - Ziad Ali
- Columbia University Medical Center, New York, USA
| | - Rickey Carter
- Department of Health Sciences Research, Mayo Clinic, Rochester, USA
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Optical Coherence Tomography Guided Percutaneous Coronary Intervention. Heart Lung Circ 2017; 26:1267-1276. [DOI: 10.1016/j.hlc.2017.07.003] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2017] [Revised: 06/05/2017] [Accepted: 07/10/2017] [Indexed: 11/23/2022]
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Romagnoli E, Gatto L, La Manna A, Burzotta F, Taglieri N, Saia F, Amico F, Marco V, Ramazzotti V, Di Giorgio A, Di Vito L, Boi A, Contarini M, Castriota F, Mintz GS, Prati F. Role of residual acute stent malapposition in percutaneous coronary interventions. Catheter Cardiovasc Interv 2017; 90:566-575. [DOI: 10.1002/ccd.26974] [Citation(s) in RCA: 37] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 08/30/2023]
Affiliation(s)
- Enrico Romagnoli
- Centro per la Lotta Contro L'Infarto - CLI Foundation; Rome Italy
| | - Laura Gatto
- Centro per la Lotta Contro L'Infarto - CLI Foundation; Rome Italy
- San Giovanni Addolorata Hospital; Rome Italy
| | | | | | | | | | | | - Valeria Marco
- Centro per la Lotta Contro L'Infarto - CLI Foundation; Rome Italy
| | | | | | | | | | | | - Fausto Castriota
- GVM Care and Research, E. S. Health Science Foundation; Cotignola Italy
| | - Gary S. Mintz
- Cardiovascular Research Foundation; New York, New York
| | - Francesco Prati
- Centro per la Lotta Contro L'Infarto - CLI Foundation; Rome Italy
- San Giovanni Addolorata Hospital; Rome Italy
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Mintz GS, Guagliumi G. Intravascular imaging in coronary artery disease. Lancet 2017; 390:793-809. [PMID: 28831995 DOI: 10.1016/s0140-6736(17)31957-8] [Citation(s) in RCA: 98] [Impact Index Per Article: 14.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/04/2017] [Revised: 06/27/2017] [Accepted: 07/05/2017] [Indexed: 12/15/2022]
Abstract
Although it is the method used by most interventional cardiologists to assess the severity of coronary artery disease and guide treatment, coronary angiography has many known limitations, particularly the fact that it is a lumenogram depicting foreshortened, shadowgraph, planar projections of the contrast-filled lumen rather than imaging the diseased vessel itself. Intravascular imaging-intravascular ultrasound and more recently optical coherence tomography-provide a tomographical or cross-sectional image of the coronary arteries. These techniques are clinically useful to answer questions such as whether the stenosis is clinically relevant; the identification of the culprit lesion; or whether the plaque (or patient) is at high risk of future adverse events. They can also be used to optimise stent implantation to minimise stent-related adverse events, provide answers to the likelihood of distal embolisation or peri-procedural myocardial infarction during stent implantation, and provide reasons for stent thrombosis or restenosis. This review considers the usefulness of intravascular imaging in day-to-day practice.
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Affiliation(s)
- Gary S Mintz
- Cardiovascular Research Foundation, New York, NY, USA.
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The fate of incomplete scaffold apposition of everolimus-eluting bioresorble scaffolds: A serial optical coherence tomography analysis. J Cardiol 2017; 70:454-460. [PMID: 28476635 DOI: 10.1016/j.jjcc.2017.03.007] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/27/2016] [Revised: 02/22/2017] [Accepted: 03/07/2017] [Indexed: 11/23/2022]
Abstract
BACKGROUND Incomplete stent apposition (ISA) can be divided into acute and late forms. Late ISA may be due to persistent ISA or late-acquired ISA (LAISA). This study evaluated the natural course of ISA after bioresorbable vascular scaffold (BRS) implantation using optical coherence tomography (OCT). METHODS Thirty-two patients (45 BRS) were assessed immediately after BRS implantation and 1 year thereafter using OCT. Acute ISA identified after BRS implantation but absent at follow-up was defined as resolved; otherwise, it was considered persistent. LAISA was defined as newly developed ISA that was identified at follow-up despite complete apposition immediately after BRS implantation. Intra-BRS fibrin-like material (IBF) was identified as an irregular intraluminal mass. ISA percentage was expressed as follows: (number of ISA/total number of BRS struts)×100. RESULTS Among 45 BRS and 15,894 analyzed BRS struts, 34 and 882 had acute ISA post-procedure, respectively. At follow-up, 92 of 15,364 analyzed struts exhibited late ISA (64 persistent ISA and 28 LAISA). In 15 of 28 struts with LAISA, LAISA occurred at the sites adjacent to post-interventional dissection. Uncovered struts were more frequently observed in late ISA compared to apposed struts (3.7±4.8 vs. 0.58±2.2%, p=0.09). IBF was significantly more common in BRS with late ISA (62.5 vs. 8.1%, p=0.02). Receiver-operating characteristic curve analysis identified a cut-off value of 280μm for acute ISA distance predicting persistent ISA. CONCLUSION Resolution of acute ISA after BRS is common. The occurrence of LAISA may be infrequent and may be a nidus of stent thrombosis.
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Suzuki K, Ishikawa T, Mutoh M, Sakamoto H, Kubota T, Ogawa T, Mori C, Hashimoto K, Komukai K, Yoshimura M. Midterm angiographic outcomes with sirolimus- and everolimus-eluting stents for small vessels in diabetic patients: propensity-score-matched comparisons in three different vessel diameters. Cardiovasc Interv Ther 2017; 33:205-216. [PMID: 28349417 DOI: 10.1007/s12928-017-0466-9] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2016] [Accepted: 03/21/2017] [Indexed: 11/30/2022]
Abstract
We conducted propensity-score-matched comparisons of midterm angiographic follow-up outcomes of sirolimus- versus everolimus-eluting stents (SES, EES) after elective placements for de novo coronary stenosis in small vessels (SV) in patients with diabetes mellitus (DM), because the angiographic efficacy of EES over SES for those cohorts remained unclear. The study was a non-randomized, retrospective, lesion-based, multicenter study, examining lesions followed up angiographically within 550 days, extracted from the unified database of 6 institutes. The endpoint (binary restenosis) was defined as the percentage of subjects having >50% diameter stenosis at follow-up. Propensity-score-matched analyses were conducted in 3 different vessel-size cohorts, defined by a preprocedural reference diameter (RD) <2.10, <2.35, and <2.60 mm, yielding group sizes of n = 107, 183, and 312 baseline-adjusted lesions in each of the 2 stent arms. The frequency of binary restenosis decreased significantly with increasing vessel size, at 16.8, 12.6, and 12.2%, in the SES group. However, it remained almost the same across vessel-size groups in the EES group (8.0, 6.0, and 7.5%). The p values for the significance of the differences in binary restenosis between EES and SES in each vessel size increased with the decrease in vessel size [p = 0.002, 0.040, and 0.063 (the last still nearly significant)]. Thus, in patients with DM, EES showed increasingly superior efficacy over SES for SV stenosis as the vessel size became smaller, i.e., the risk for binary restenosis became greater.
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Affiliation(s)
- Kenichiro Suzuki
- Division of Cardiology, Department of Internal Medicine, Jikei University, Kashiwa Hospital, 163-1 Kashiwa-shita, Kashiwa, Chiba, 267-0004, Japan
| | - Tetsuya Ishikawa
- Division of Cardiology, Department of Internal Medicine, Jikei University, Kashiwa Hospital, 163-1 Kashiwa-shita, Kashiwa, Chiba, 267-0004, Japan. .,Division of Cardiology, Saitama Cardiovascular Respiratory Center, Kumagaya, Saitama, Japan.
| | - Makoto Mutoh
- Division of Cardiology, Saitama Cardiovascular Respiratory Center, Kumagaya, Saitama, Japan
| | - Hiroshi Sakamoto
- Division of Cardiology, Fuji City General Hospital, Fuji, Shizuoka, Japan
| | - Takeyuki Kubota
- Division of Cardiology, Department of Internal Medicine, Jikei University, Kashiwa Hospital, 163-1 Kashiwa-shita, Kashiwa, Chiba, 267-0004, Japan
| | - Takayuki Ogawa
- Division of Cardiology, Department of Internal Medicine, Jikei University School of Medicine, Tokyo, Japan
| | - Chikara Mori
- Division of Cardiology, Department of Internal Medicine, Jikei University School of Medicine, Daisan Hospital, Tokyo, Japan
| | - Koichi Hashimoto
- Division of Cardiology, Nishisaitama-chuo National Hospital, Tokorozawa, Saitama, Japan
| | - Kimiaki Komukai
- Division of Cardiology, Department of Internal Medicine, Jikei University, Kashiwa Hospital, 163-1 Kashiwa-shita, Kashiwa, Chiba, 267-0004, Japan
| | - Michihiro Yoshimura
- Division of Cardiology, Department of Internal Medicine, Jikei University School of Medicine, Tokyo, Japan
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Sotomi Y, Onuma Y, Dijkstra J, Miyazaki Y, Kozuma K, Tanabe K, Popma JJ, de Winter RJ, Serruys PW, Kimura T. Fate of post-procedural malapposition of everolimus-eluting polymeric bioresorbable scaffold and everolimus-eluting cobalt chromium metallic stent in human coronary arteries: sequential assessment with optical coherence tomography in ABSORB Japan trial. Eur Heart J Cardiovasc Imaging 2017; 19:59-66. [DOI: 10.1093/ehjci/jew329] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/08/2016] [Accepted: 12/21/2016] [Indexed: 11/14/2022] Open
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Ishida K, Otsuki S, Giacchi G, Ortega-Paz L, Shiratori Y, Freixa X, Martín-Yuste V, Masotti M, Sabaté M, Brugaletta S. Serial optical coherence tomography assessment of malapposed struts after everolimus-eluting stent implantation. A subanalysis from the HEAL-EES study. CARDIOVASCULAR REVASCULARIZATION MEDICINE 2016; 18:47-52. [PMID: 27634493 DOI: 10.1016/j.carrev.2016.08.010] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2016] [Accepted: 08/31/2016] [Indexed: 11/16/2022]
Abstract
BACKGROUND Incomplete stent apposition (ISA) is related to stent thrombosis, which is a serious adverse event. We aim to assess the time-course of ISA after 2nd generation everolimus-eluting stent (EES) implantation. METHODS In HEAL-EES study, we enrolled 36 patients who underwent percutaneous coronary intervention (PCI) with EES. OCT imaging was performed at baseline and follow-up. Patients were randomized 1:1:1 into 3 groups according to the time in which follow-up was performed: group A (6-month), group B (9-month), and group C (12-month). In this subanalysis, patients who had ISA segments at baseline and/or follow-up OCT were analyzed. RESULT At baseline, among 41 lesions in 36 patients, 20 lesions in 18 patients had ISA segments and were analyzed. At baseline, there were 3.0% ISA struts in group A (n=8), 2.8% in group B (n=4), and 4.5% in group C (n=8). At follow-up, ISA struts were present in 0.09%, 0.16% and 0.64%; respectively in groups A, B, and C. At follow-up, there was a significant decrease in the frequency of ISA: group A 3.0% vs. 0.09% (p<0.001), group B 2.8% vs. 0.16% (p<0.001), and group C 4.5% vs. 0.64% (p<0.001). In group A, there was one late acquired ISA at follow-up. CONCLUSIONS In patients undergoing 2nd generation EES implantation, area of acute ISA assessed by OCT, was almost resolved at 6-month follow-up.
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Affiliation(s)
- Kohki Ishida
- Cardiology Department, Cardiovascular Institute, Hospital Clínic, Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), University of Barcelona, Barcelona, Spain
| | - Shuji Otsuki
- Division of Cardiology, Teikyo University Hospital, Tokyo, Japan
| | - Giuseppe Giacchi
- Cardiology Department, Cardiovascular Institute, Hospital Clínic, Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), University of Barcelona, Barcelona, Spain
| | - Luis Ortega-Paz
- Cardiology Department, Cardiovascular Institute, Hospital Clínic, Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), University of Barcelona, Barcelona, Spain
| | | | - Xavier Freixa
- Cardiology Department, Cardiovascular Institute, Hospital Clínic, Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), University of Barcelona, Barcelona, Spain
| | - Victoria Martín-Yuste
- Cardiology Department, Cardiovascular Institute, Hospital Clínic, Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), University of Barcelona, Barcelona, Spain
| | - Mónica Masotti
- Cardiology Department, Cardiovascular Institute, Hospital Clínic, Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), University of Barcelona, Barcelona, Spain
| | - Manel Sabaté
- Cardiology Department, Cardiovascular Institute, Hospital Clínic, Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), University of Barcelona, Barcelona, Spain
| | - Salvatore Brugaletta
- Cardiology Department, Cardiovascular Institute, Hospital Clínic, Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), University of Barcelona, Barcelona, Spain.
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Mori H, Joner M, Finn AV, Virmani R. Malapposition: is it a major cause of stent thrombosis? Eur Heart J 2016; 37:1217-1219. [DOI: 10.1093/eurheartj/ehw006] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 08/30/2023] Open
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Tokuda T, Yamawaki M, Takahara M, Mori S, Makino K, Honda Y, Takafuji H, Takama T, Tsutsumi M, Sakamoto Y, Takimura H, Kobayashi N, Araki M, Hirano K, Ito Y. Comparison of Long-Term Clinical Outcomes of Lesions Exhibiting Focal and Segmental Peri-Stent Contrast Staining. J Am Heart Assoc 2016; 5:e002878. [PMID: 26994133 PMCID: PMC4943264 DOI: 10.1161/jaha.115.002878] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
Background Peri‐stent contrast staining (PSS) after metallic drug‐eluting stent deployment is associated with target lesion revascularization and very late stent thrombosis. However, the type of PSS that influences the clinical outcomes is unknown. Therefore, we aimed to reveal which PSS type was influencing clinical outcomes. Methods and Results This study included 5580 de novo lesions of 4405 patients who were implanted with a first‐ or second‐generation drug‐eluting stent and who were evaluated using follow‐up angiography within 12 months after stent implantation. We compared the clinical outcomes of patients divided into focal PSS and segmental PSS groups for 6 years after stent implantation. Total PSS was observed in 97 lesions (2.2%), of which 42 and 55 lesions were focal and segmental PSS, respectively. Baseline characteristics were similar between groups, except for intraoperative chronic total occlusion (segmental PSS=47.3% versus focal PSS=11.9%, P=0.0001). The incidence of segmental PSS tended to be higher in patients with a first‐generation drug‐eluting stent (83.6% versus 16.4%, P=0.05). The cumulative incidence of stent thrombosis in the 6 years of segmental PSS group was significantly higher than that of the focal PSS group (13.9% versus 0%, P=0.04). The cumulative incidence of overall target lesion revascularization for restenosis, excluding target lesion revascularization procedures for stent thrombosis, was significantly higher in the segmental PSS group (38.0% versus 0%, P=0.01). Conclusions The incidence of segmental PSS tended to be higher in patients with a first‐generation drug‐eluting stent and appeared to be significantly associated with target lesion revascularization and stent thrombosis.
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Affiliation(s)
- Takahiro Tokuda
- Department of Cardiovascular Medicine, Saiseikai Yokohama City Eastern Hospital, Yokohama, Kanagawa, Japan
| | - Masahiro Yamawaki
- Department of Cardiovascular Medicine, Saiseikai Yokohama City Eastern Hospital, Yokohama, Kanagawa, Japan
| | - Mitsuyohi Takahara
- Department of Diabetes Care Medicine, Osaka University Graduate School of Medicine, Suita City, Osaka, Japan
| | - Shinsuke Mori
- Department of Cardiovascular Medicine, Saiseikai Yokohama City Eastern Hospital, Yokohama, Kanagawa, Japan
| | - Kenji Makino
- Department of Cardiovascular Medicine, Saiseikai Yokohama City Eastern Hospital, Yokohama, Kanagawa, Japan
| | - Yosuke Honda
- Department of Cardiovascular Medicine, Saiseikai Yokohama City Eastern Hospital, Yokohama, Kanagawa, Japan
| | - Hiroya Takafuji
- Department of Cardiovascular Medicine, Saiseikai Yokohama City Eastern Hospital, Yokohama, Kanagawa, Japan
| | - Takuro Takama
- Department of Cardiovascular Medicine, Saiseikai Yokohama City Eastern Hospital, Yokohama, Kanagawa, Japan
| | - Masakazu Tsutsumi
- Department of Cardiovascular Medicine, Saiseikai Yokohama City Eastern Hospital, Yokohama, Kanagawa, Japan
| | - Yasunari Sakamoto
- Department of Cardiovascular Medicine, Saiseikai Yokohama City Eastern Hospital, Yokohama, Kanagawa, Japan
| | - Hideyuki Takimura
- Department of Cardiovascular Medicine, Saiseikai Yokohama City Eastern Hospital, Yokohama, Kanagawa, Japan
| | - Norihiro Kobayashi
- Department of Cardiovascular Medicine, Saiseikai Yokohama City Eastern Hospital, Yokohama, Kanagawa, Japan
| | - Motoharu Araki
- Department of Cardiovascular Medicine, Saiseikai Yokohama City Eastern Hospital, Yokohama, Kanagawa, Japan
| | - Keisuke Hirano
- Department of Cardiovascular Medicine, Saiseikai Yokohama City Eastern Hospital, Yokohama, Kanagawa, Japan
| | - Yoshiaki Ito
- Department of Cardiovascular Medicine, Saiseikai Yokohama City Eastern Hospital, Yokohama, Kanagawa, Japan
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Tokuda T, Yamawaki M, Mori S, Takimura H, Sakamoto Y, Kobayashi N, Araki M, Hirano K, Ito Y. Risk Factors and Clinical Impacts of Peri-Stent Contrast Staining After Second-Generation Drug-Eluting Stent Implantation. J Interv Cardiol 2016; 29:179-87. [PMID: 26822952 DOI: 10.1111/joic.12282] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
BACKGROUND Peri-stent contrast staining (PSS) after sirolimus-eluting stent implantation is associated with target lesion revascularization (TLR) and very late stent thrombosis. However, the risk factors and clinical sequelae of PSS after second-generation DES implantation remain unclear. METHODS AND RESULTS This study comprised 2,090 patients with 2,883 lesions treated with second-generation DES from April 2009 to February 2013. Angiographic findings and clinical outcomes were compared between PSS and non-PSS groups. Follow-up angiography was available for 2,411 lesions. PSS was observed in 23 lesions: 4 in biolimus-eluting stents, 4 in zotarolimus-eluting stents (ZES), and 15 in everolimus-eluting stents (EES). Right coronary artery lesions, chronic total occlusion (CTO), and lesions with severe angulation (>90°) were more frequent in the PSS group compared with the non-PSS group. Lesions were longer and the cumulative TLR incidence at 3 years was higher in the PSS group than those in the non-PSS group (27.9 mm vs. 19.4 mm, P < 0.0001; 27.4% vs. 8.6%, P = 0.0002). There was no significant difference in stent thrombosis between the two groups. Multivariable analysis identified CTO [odds ratio (OR) 3.75, 95%CI 1.52-8.88, P = 0.005] as an independent predictor of PSS. CONCLUSIONS PSS after second-generation DES implantation was associated with an increased risk of subsequent TLR. CTO was the independent predictor of PSS.
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Affiliation(s)
- Takahiro Tokuda
- Department of Cardiovascular Medicine, Saiseikai Yokohama City Eastern Hospital, Yokohama, Kanagawa, Japan
| | - Masahiro Yamawaki
- Department of Cardiovascular Medicine, Saiseikai Yokohama City Eastern Hospital, Yokohama, Kanagawa, Japan
| | - Shinsuke Mori
- Department of Cardiovascular Medicine, Saiseikai Yokohama City Eastern Hospital, Yokohama, Kanagawa, Japan
| | - Hideyuki Takimura
- Department of Cardiovascular Medicine, Saiseikai Yokohama City Eastern Hospital, Yokohama, Kanagawa, Japan
| | - Yasunari Sakamoto
- Department of Cardiovascular Medicine, Saiseikai Yokohama City Eastern Hospital, Yokohama, Kanagawa, Japan
| | - Norihiro Kobayashi
- Department of Cardiovascular Medicine, Saiseikai Yokohama City Eastern Hospital, Yokohama, Kanagawa, Japan
| | - Motoharu Araki
- Department of Cardiovascular Medicine, Saiseikai Yokohama City Eastern Hospital, Yokohama, Kanagawa, Japan
| | - Keisuke Hirano
- Department of Cardiovascular Medicine, Saiseikai Yokohama City Eastern Hospital, Yokohama, Kanagawa, Japan
| | - Yoshiaki Ito
- Department of Cardiovascular Medicine, Saiseikai Yokohama City Eastern Hospital, Yokohama, Kanagawa, Japan
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Intravascular optical coherence tomography for the evaluation of arterial bifurcations covered by flow diverters. J Neurointerv Surg 2016; 8:1283-1287. [DOI: 10.1136/neurintsurg-2015-012084] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2015] [Revised: 12/30/2015] [Accepted: 12/31/2015] [Indexed: 11/03/2022]
Abstract
Background and objectiveDue to its high spatial resolution, intravascular optical coherence tomography (OCT) has been used as a valid method for in vivo evaluation of several types of coronary stents at straight lumen and bifurcation sites. We sought to evaluate its effectiveness for flow diverting stents deployed in arterial bifurcation sites involving jailing of a side branch.MethodsFour large white swine were stented with flow diverting stents covering the right common carotid artery–ascending pharyngeal artery bifurcation. After 12 weeks of follow-up the animals were evaluated by digital subtraction angiography and intravascular OCT and subsequently sacrificed. Neointimal thickness on the parent arteries and the free segments of the stent were measured. The stented arteries were harvested and underwent scanning electron microscopy (SEM) imaging. Ostia surface values were measured with OCT three-dimensional (3D) reconstructions and SEM images.ResultsAll endovascular procedures and OCT pullback runs were feasible. Stent apposition was satisfactory on the immediate post-stent OCT reconstructions. At 12-week controls, all stents and jailed branches were patent. Mean neointimal thickness was 0.11±0.04 mm on the free segments of the stent. The mean ostia surface at 12 weeks was 319 750±345 533 μm2 with 3D-OCT reconstructions and 351 198±396 355 μm2 with SEM image-derived calculations. Good correlation was found for ostia surface values between the two techniques; the values did not differ significantly in this preliminary study.ConclusionsIntravascular OCT appears to be a promising technique for immediate and follow-up assessment of the orifice of arterial branches covered by flow diverting stents.
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Souteyrand G, Amabile N, Mangin L, Chabin X, Meneveau N, Cayla G, Vanzetto G, Barnay P, Trouillet C, Rioufol G, Rangé G, Teiger E, Delaunay R, Dubreuil O, Lhermusier T, Mulliez A, Levesque S, Belle L, Caussin C, Motreff P. Mechanisms of stent thrombosis analysed by optical coherence tomography: insights from the national PESTO French registry. Eur Heart J 2016; 37:1208-16. [DOI: 10.1093/eurheartj/ehv711] [Citation(s) in RCA: 205] [Impact Index Per Article: 25.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/19/2015] [Accepted: 12/03/2015] [Indexed: 11/13/2022] Open
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Duration of dual antiplatelet therapy after drug-eluting stent implantation: Meta-analysis of large randomised controlled trials. Sci Rep 2015; 5:13204. [PMID: 26278959 PMCID: PMC4538605 DOI: 10.1038/srep13204] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2015] [Accepted: 07/15/2015] [Indexed: 12/18/2022] Open
Abstract
Patients receive dual antiplatelet therapy (DAPT) for 6–12 months after drug-eluting stents (DES) implantation. The efficacy and safety of prolonged DAPT has been questioned. Therefore, we performed a meta-analysis on randomised trials comparing different DAPT durations. Literature was searched on trials comparing different DAPT durations. For inclusion, reports must report frequency of cardiovascular and bleeding events. Ten trials were included. Compared to 12 months, DAPT beyond 12 months was associated with fewer myocardial infarctions (OR 0.58 95%CI: 0.40–0.84) and stent thrombosis (OR 0.35 95%CI: 0.20–0.62), but more major bleeds (OR 1.60 95%CI: 1.22–2.11) and all-cause (OR 1.30 95%CI: 1.02–1.66) mortality. There was no significant alteration in risk of stroke (OR 0.93 95%CI: 0.66–1.31) or cardiac (OR 1.12 95%CI: 0.73–1.71) mortality. Compared to less than 12 months DAPT, 12 months DAPT did not reduce risk of myocardial infarction, stent thrombosis, strokes, cardiac or all-cause mortality, but increased the risk of major bleeds (OR 1.60 95%CI: 1.22–2.11). DAPT beyond 12 months reduce risk of myocardial infarction and stent thrombosis, but there is substantial increase in major bleeding risk and all-cause mortality which need to be addressed. DAPT beyond 12 months does not appear to alter the risk of stroke.
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Toyota T, Shiomi H, Morimoto T, Kimura T. Meta-analysis of long-term clinical outcomes of everolimus-eluting stents. Am J Cardiol 2015; 116:187-94. [PMID: 25960378 DOI: 10.1016/j.amjcard.2015.03.059] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/24/2015] [Revised: 03/31/2015] [Accepted: 03/31/2015] [Indexed: 11/16/2022]
Abstract
The superiority of everolimus-eluting stents (EES) over sirolimus-eluting stents (SES) for long-term clinical outcomes has not been yet firmly established. We conducted a systematic review and a meta-analysis of randomized controlled trials (RCTs) comparing EES directly with SES using the longest available follow-up data. We searched PubMed, the Cochrane database, and ClinicalTrials.gov for RCTs comparing outcomes between EES and SES and identified 13,434 randomly assigned patients from 14 RCTs. EES was associated with significantly lower risks than SES for definite stent thrombosis (ST), definite/probable ST, target-lesion revascularization (TLR), and major adverse cardiac events (MACE). The risks for all-cause death and myocardial infarction were similar between EES and SES. By the stratified analysis according to the timing after stent implantation, the favorable trend of EES relative to SES for ST, TLR, and MACE was consistently observed both within and beyond 1 year. The lower risk of EES relative to SES for MACE beyond 1 year was statistically significant (pooled odds ratio 0.77, 95% confidence interval 0.61 to 0.96, p = 0.02). In conclusion, the current meta-analysis of 14 RCTs directly comparing EES with SES suggested that EES provided improvement in both safety and efficacy; EES compared with SES was associated with significantly lower risk for definite ST, definite/probable ST, TLR, and MACE. The direction and magnitude of the effect beyond 1 year were comparable with those observed within 1 year.
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Affiliation(s)
- Toshiaki Toyota
- Department of Cardiovascular Medicine, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - Hiroki Shiomi
- Department of Cardiovascular Medicine, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - Takeshi Morimoto
- Division of General Medicine, Department of Internal Medicine, Hyogo College of Medicine, Hyogo, Japan
| | - Takeshi Kimura
- Department of Cardiovascular Medicine, Graduate School of Medicine, Kyoto University, Kyoto, Japan.
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Maehara A, Matsumura M, Mintz GS. Assessment and Quantitation of Stent Results by Intracoronary Optical Coherence Tomography. Interv Cardiol Clin 2015; 4:285-294. [PMID: 28581945 DOI: 10.1016/j.iccl.2015.02.003] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Optical coherence tomography evaluation of poststent results includes stent expansion as the absolute minimum stent area ratio by comparing the minimum stent area with the proximal and distal reference lumen areas or mean stent area defined as the total stent volume divided by the analyzed stent length; stent strut malapposition defined when the distance from the center of the blooming artifact and the surface of plaque is greater than the sum of stent thickness and polymer thickness; tissue protrusion through the stent struts; semiquantitative residual thrombus evaluation; and stent edge dissection.
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Affiliation(s)
- Akiko Maehara
- Department of Medicine, Columbia University Medical Center, 161 Fort Washington Avenue, New York, NY 10032, USA; Clinical Trials Center, Cardiovascular Research Foundation, 111 East 59th Street, 12th Floor, New York, NY 10022, USA.
| | - Mitsuaki Matsumura
- Clinical Trials Center, Cardiovascular Research Foundation, 111 East 59th Street, 12th Floor, New York, NY 10022, USA
| | - Gary S Mintz
- Clinical Trials Center, Cardiovascular Research Foundation, 111 East 59th Street, 12th Floor, New York, NY 10022, USA
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