Intravascular Ultrasound Parameters Associated With Stent Thrombosis After Drug-Eluting Stent Deployment

Okabe, Teruo; Mintz, Gary S.; Buch, Ashesh N.; Roy, Probal; Hong, Young Joon; Smith, Kimberly A.; Torguson, Rebecca; Gevorkian, Natalie; Zhang, Xue; Satler, Lowell F.; Kent, Kenneth M.; Pichard, Augusto D.; Weissman, Neil J.; Waksman, Ron

doi:10.1016/j.amjcard.2007.03.072

Cited by 160 publications

(82 citation statements)

References 29 publications

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“…58 Although published data on DES thrombosis are still limited, several small IVUS studies have suggested stent underexpansion and significant residual reference disease as risk factors of acute, subacute or late DES thrombosis (Figure 7). [59][60][61] Some investigator groups have also suggested baseline or late ISA as another possible risk factor. 53,[59][60][61] However, there is significant overlap in each risk factor between thrombosis and non-thrombosis cases, undoubtedly representing a multifactorial process of this phenomenon.…”

Section: Insights Into Optimal Deployment Techniquementioning

confidence: 99%

“…[59][60][61] Some investigator groups have also suggested baseline or late ISA as another possible risk factor. 53,[59][60][61] However, there is significant overlap in each risk factor between thrombosis and non-thrombosis cases, undoubtedly representing a multifactorial process of this phenomenon. Nevertheless, the importance of procedural optimization cannot be overemphasized because these risk factors are the only variables that operators could alter in the cardiac catheterization laboratory.…”

Section: Insights Into Optimal Deployment Techniquementioning

confidence: 99%

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Drug-Eluting Stents Insights From Invasive Imaging Technologies

Honda

2009

Circ J

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n the history of percutaneous coronary intervention, drug-eluting stents (DES) are recognized as revolutionary technologies with their unique ability to provide both mechanical and biological solutions simultaneously to the target lesion. While the clinical success of DES depends on these 2 properties, the ability of the operator to properly deploy the device is also of utmost importance. Although contrast angiography remains the clinical standard for coronary imaging, this conventional method provides very little information about in vivo device properties and their effects on the arterial wall. In contrast, catheter-based imaging tools, such as intravascular ultrasound (IVUS), optical coherence tomography (OCT), and intracoronary angioscopy can offer unique insights into novel interventional technologies through direct assessment of the device and the treated vessel. This article will review our multimodality insights into current DES, focusing on performance, safety, and an optimal deployment technique. Performance Characteristics Neointimal HyperplasiaSpatial Distribution IVUS observations from clinical experience with antiproliferative DES have shown a striking inhibition of in-stent neointimal hyperplasia. In addition to the absolute amount of neointimal hyperplasia, significant differences can be observed in its spatial distribution within conventional bare metal stents (BMS) vs current DES.In BMS, several IVUS studies reported an association between the native plaque burden and subsequent neointimal hyperplasia in terms of both circumferential and longitudinal distributions within the stent. 1 On average, across most patients, a wide individual variation in native disease along the target segment generally results in a relatively even neointimal distribution throughout the stent. Drug-Eluting Stents Insights From Invasive Imaging TechnologiesYasuhiro Honda, MD Drug-eluting stents (DES) represent a revolutionary technology in their unique ability to provide both mechanical and biological solutions simultaneously to the target lesion. As a result of biological effects from the pharmacological agents and interaction of DES components with the arterial wall, considerable differences exist between DES and conventional bare metal stents (BMS), yet some of the old lessons learned in the BMS era remain clinically significant. In this context, contrast angiography provides very little information about in vivo device properties and their biomechanical effects on the arterial wall. In contrast, current catheter-based imaging tools, such as intravascular ultrasound, optical coherence tomography, and intracoronary angioscopy can offer unique insights into DES through direct assessment of the device and treated vessel in the clinical setting. This article reviews these insights from current DES with particular focus on performance and safety characteristics as well as discussing an optimal deployment technique, based upon findings obtained through the use of the invasive imaging technologies. On the contrary, if the...

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Section: Insights Into Optimal Deployment Techniquementioning

confidence: 99%

Section: Insights Into Optimal Deployment Techniquementioning

confidence: 99%

Drug-Eluting Stents Insights From Invasive Imaging Technologies

Honda

2009

Circ J

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“…Implantation of a stent of inappropriate length (too short) is associated with higher risk of edge dissection and the phenomenon of "geographical miss", which are responsible for increased risk of restenosis and in-stent thrombosis. On the other hand, excessive length of the stent implanted was also found to correlate with risk of restenosis [12] and stent thrombosis [13][14][15][16][17]. In everyday practice the intracoronary lesion length during the PCI procedure is assessed with one of three conventional methods, none of which is optimal.…”

Section: Analityków (Zmienność Pomiędzy Obserwatorami) Wykres Ilustrmentioning

confidence: 99%

“…It may provide accurate measurements of intracoronary lengths and 3D mapping of the coronary arteries, facilitating visualization of vessel curvature, elimination of foreshortening and measurement of vessel length [4,11]. This has been increasingly important in the drug-eluting stent era, when appropriate coverage of lesion with the stent is imperative to avoid edge restenosis [12], as well as to decrease the risk of stent thrombosis, which was found to correlate with stent length [13][14][15][16][17].…”

Section: Introductionmentioning

confidence: 99%

Comparison of 3-dimensional and 2-dimensional quantitative coronary analysis measuring intracoronary lengths in patients undergoing diagnostic coronary angiography

Legutko¹,

Rzeszutko²,

Partyka³

et al. 2012

pwki

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A b s t r a c tAim: To determine if three-dimensional quantitative coronary angiographic analysis (3D QCA) provides an advantage over twodimensional (2D QCA) by increasing accuracy and precision of length measurements through compensating for foreshortening inherent to 2D images.Material and methods: A total of 800 inter-marker length measurements were performed (8 per wire, 5-40 mm) with novel 3D software and standard 2D software and compared with the true lengths of the inter-marker distances on the wire in coronary vessels of 21 patients recruited.Results: 2D QCA generally underestimated true length in comparison to 3D, and the discrepancy increased with absolute length. In contrast, 3D QCA showed a minimal difference from true length over the examined range of lengths.Conclusions: 3D QCA minimizes errors in length measurements associated with foreshortening, shows minimal difference from true length, and performs significantly better in comparison to 2D QCA. The advantage of 3D QCA is more pronounced at longer lengths.Key words: 3D, 2D, quantitative coronary angiography (QCA) S t r e s z c z e n i e Cel: Określenie, czy trójwymiarowa, ilościowa analiza angiograficzna naczyń wieńcowych (3D QCA) ma przewagę nad standardową oceną dwuwymiarową (2D QCA) polegającą na zwiększeniu dokładności i precyzji pomiarów długości oraz wyeliminowaniu skrócenia typowego dla analiz 2D.Materiał i metody: Wykonano ogółem 800 pomiarów długości odcinka pomiędzy markerami na prowadnikach wieńcowych wprowadzonych do tętnicy wieńcowej (8 długości na prowadniku w zakresie 5-40 mm) z zastosowaniem oprogramowania 3D i standardowego oprogramowania 2D w porównaniu ze znanymi odległościami znaczników na prowadniku wieńcowym u 21 pacjentów poddanych koronarografii.Wyniki: W analizie 2D QCA pomiary były z reguły zaniżone w stosunku do rzeczywistej długości mierzonego odcinka, przy czym wielkość błędu wzrastała wraz z bezwzględną długością mierzonego odcinka. Analizy za pomocą 3D QCA wykazały minimalne różnice pomiarów w stosunku do rzeczywistych odległości pomiędzy markerami w całym zakresie badanych długości.

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“…46 Furthermore, the reduced risk of instent restenosis in patients undergoing DES implantation is offset by concerns about stent thrombosis. 47 The increased use of DES has increased the identification of complex lesions and the need for complicated procedures and has led to the treatment of more high-risk patients. 48,49 Indeed, IVUS measurements of stent length and minimum stent lumen area have influenced the long-term outcomes of DES stenting.…”

Section: Role Of Intravascular Ultrasound In Percutaneous Coronary Inmentioning

confidence: 99%