Delayed coverage of drug-eluting stents after interventional revascularisation of chronic total occlusions assessed by optical coherence tomography: the ALSTER-OCT-CTO registry

Heeger, Christian‐Hendrik; Busjahn, Andreas; Hildebrand, Laura de Campos; Fenski, Maximillian; Lesche, Felix; Meincke, Felix; Kück, Karl‐Heinz; Bergmann, Martin

doi:10.4244/eijy14m10_01

Cited by 24 publications

(26 citation statements)

References 32 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…On the other hand, the thicker neointimal coverage of DES in truelumen in CTO lesions might lead to in-stent restenosis. Heeger et al reported that significantly delayed DES coverage after CTO-PCI was observed, but they did not evaluate whether DES was implanted in subintima or in true-lumen using IVUS or OCT [28]. In addition, their study used different type DESs while we used only EES.…”

Section: Discussionmentioning

confidence: 99%

Neointimal Characteristics after Everolimus-Eluting Stents Implantation for Chronic Total Occlusion: An Optical Coherence Tomographic Study

Okamoto¹,

Yasumura²,

Yasumoto³

et al. 2017

Interv Cardiol J

View full text Add to dashboard Cite

Objectives: We investigated neointimal characteristics after everolimus-eluting stent (EES) implantation in chronic total occlusion (CTO) using optical coherence tomography (OCT).Background: CTO is one of the major risk factors for restenosis and reocclusion even in drug-eluting stent era, but detailed neointimal characteristics after stent implantation in CTO is unclear. Methods:We divided our patients (35 EESs) into three groups: patients with stenting for non-CTO lesions (non-CTO group), patients with subintimal stenting (CTO subintima group) and with intra true-lumen stenting for CTO lesions (CTO true lumen group). We compared OCT parameters included the percentage of neointimal hyperplasia area obstruction (%NHAO), mean neointimal hyperplasia (NIH) thickness, the proportion of uncovered struts, the proportion of malapposed struts at cross sectional level and at strut level among three groups.Results: NIH and %NHAO were significantly lowest in CTO subintima group (5 EESs) and highest in CTO true-lumen group (4 EESs) (CTO subintima vs. CTO true-lumen vs. non- , respectively) while the proportions of uncovered struts and malapposed struts were significantly highest in CTO subintima group and significantly lowest in CTO true-lumen group among the three groups (CTO subintima vs. CTO true-lumen vs. non-CTO: 109 (18.7) vs. 47 (4.7) vs. 375 (7.9) and 36 (6.2) vs. 0 (0) vs. 45 (0.95), respectively). Conclusions:We revealed by OCT that stents implanted in subintima in CTO lesions may have more risks related to stent thrombosis such as malapposed struts and uncovered struts, while stents implanted in true lumen in CTO lesions may have thicker neointimal coverage that might have occurred restenosis.

show abstract

Section: Discussionmentioning

confidence: 99%

Neointimal Characteristics after Everolimus-Eluting Stents Implantation for Chronic Total Occlusion: An Optical Coherence Tomographic Study

Okamoto¹,

Yasumura²,

Yasumoto³

et al. 2017

Interv Cardiol J

View full text Add to dashboard Cite

show abstract

“…As recently described acquired data was analyzed at the LightLab Imaging OCT-offline workstation (OCT-system software B.0.1, LightLab) [13,14]. Image assessments were performed in every 5 th cross-section.…”

Section: Oct-imaging and Analysis At Follow-upmentioning

confidence: 99%

“…Frequency domain OCT-pullbacks were performed according to guidelines and obtained with the Ilumien system (St. Jude Medical, Saint Paul, USA) [13,14,20,21]. As recently described acquired data was analyzed at the LightLab Imaging OCT-offline workstation (OCT-system software B.0.1, LightLab) [13,14].…”

Section: Oct-imaging and Analysis At Follow-upmentioning

confidence: 99%

“…Target-lesion-failure was defined as a composite of cardiac death, target-vessel myocardial infarction (MI), ischemia driven target-lesion-revascularization (TLR) within 2 years [13,14,24]. Target-vessel-revascularisation (TVR) was defined as non-target lesion revascularization of the target vessel [13,14,25].…”

Section: Clinical Follow-upmentioning

confidence: 99%

“…Aside from guidance during PCI, OCT has become a powerful tool to evaluate DES and BVS--coverage and apposition in follow-up examinations. Quantitative data from follow-up OCT-imaging has been proposed as surrogate parameters for stent performance linked to clinical outcome [12][13][14][15][16]. The present ALSTER-OCT ABSORB registry (AskLepios ST. GEoRg's hospital-Optical Coherence Tomography for follow-up of ABSORBable vascular scaffolds) analyzed OCT-data regarding BVS-coverage, neointimal thickness and apposition at 6 months following EE-BVS-implantation.…”

Section: Introductionmentioning

confidence: 99%

See 2 more Smart Citations

Optical coherence tomography-guided versus angiography-guided implantation of everolimus-eluting bioresorbable vascular scaffolds: Comparison of coverage, apposition and clinical outcome. The ALSTER-OCT ABSORB registry

et al. 2018

Self Cite

View full text Add to dashboard Cite

Background: Suboptimal implantation of everolimus-eluting bioresorbable vascular scaffolds (EE--BVS) leading to strut malapposition and lack of neointima coverage has been hypothesized to be linked to late BVS-thrombosis. Optical coherence tomography (OCT) allows assessing subtle differences in BVS--healing. We aimed to link 6-months OCT-data on EE-BVS coverage and malapposition to implantation technique and clinical outcome. Methods: Twenty-nine consecutive EE-BVS-patients were included. EE-BVS-implantation was guided by angiography in the first 17 patients (group 1). Vessel sizing prior to implantation and implantation result was assessed by OCT in the 12 following patients (group 2). EE-BVS-implantation was performed in both groups with adequate lesion preparation, sizing and systematic high-pressure post-dilatation. All patients received 6-months invasive control including OCT-analysis and clinical follow-up for 2 years.Results: The rate of uncovered struts was group 1: 10.8 ± 10.0%; group 2: 10.6 ± 8.2%, p = 0.934. Target lesion failure due to BVS-thrombosis occurred in 2/17 patients at 9 and 18 months (11.8%, group 1), and no patients in group 2 (p = 0.218). (Cardiol J 2018; 25, 4: 459-469) Conclusions: Optical coherence tomography analysis at 6-months following EE-BVS-implantation finds almost 90% of struts to be covered. No difference between OCT vs. angiography-guided EE-BVS--implantation was observed. OCT at 6-months was not able to predict late BVS-thrombosis of EE-BVS.

show abstract

Intraplaque wiring enables drug‐coated balloons to be utilized for percutaneous recanalization of chronically occluded coronary arteries

Terashita

Shimada

Yamanaka

et al. 2023

Cathet Cardio Intervent

View full text Add to dashboard Cite

Objectives This study aimed to determine whether drug‐coated balloon (DCB) angioplasty following intraplaque wiring and the use of modified balloons is safe and effective in the percutaneous treatment of coronary chronic total occlusions (CTOs). Background DCB is an alternative therapeutic option without the limitations of permanent vascular implants. However, its efficacy in CTOs has yet to be confirmed. The combination of modified balloons and DCB can be effectively applied when the intraplaque passage of the guidewire is achieved in CTOs. Methods Data from 124 consecutive CTO lesions (105 patients) treated at our hospital between February 2016 and December 2020 were screened for inclusion and retrospectively analyzed. Among the 118 lesions successfully recanalized, intraplaque wiring was achieved in 108, and 85 were treated by the DCB‐only approach following cutting/scoring balloon dilatation. Results Follow‐up data were available for 82 lesions (71 patients). The median occlusion length was 18.5 mm, and the J‐CTO score was 1.7 ± 0.9. No in‐hospital major adverse cardiac events occurred, including abrupt vessel closure. During the median 29‐month follow‐up period, target lesion revascularization was performed for 10 lesions. Follow‐up coronary angiography (8.7 ± 3.9 months after the index procedure) was performed for 64 lesions, demonstrating late lumen loss of −0.15 mm (interquartile range −0.4 to 0.23 mm), binary restenosis (diameter stenosis ≥50%) in 12 lesions (18.8%), and late lumen enlargement in 37 (57.8%). Conclusion The DCB‐only approach following the use of modified balloons is a promising strategy for coronary CTOs when intraplaque wiring is achieved.

show abstract

Delayed coverage of drug-eluting stents after interventional revascularisation of chronic total occlusions assessed by optical coherence tomography: the ALSTER-OCT-CTO registry

Abstract: A significantly delayed DES coverage after CTO-PCI was observed. Given the known increased rate of ST following CTO-PCI and the known association between delayed DES coverage and ST, OCT may aid in determining the optimal duration of dual antiplatelet therapy after CTO-PCI.

Cited by 24 publications

References 32 publications

Neointimal Characteristics after Everolimus-Eluting Stents Implantation for Chronic Total Occlusion: An Optical Coherence Tomographic Study

Neointimal Characteristics after Everolimus-Eluting Stents Implantation for Chronic Total Occlusion: An Optical Coherence Tomographic Study

Optical coherence tomography-guided versus angiography-guided implantation of everolimus-eluting bioresorbable vascular scaffolds: Comparison of coverage, apposition and clinical outcome. The ALSTER-OCT ABSORB registry

Intraplaque wiring enables drug‐coated balloons to be utilized for percutaneous recanalization of chronically occluded coronary arteries

Contact Info

Product

Resources

About