Intravascular Ultrasound Predictors for Edge Restenosis After Newer Generation Drug-Eluting Stent Implantation

Kang, Soo–Jin; Cho, Young‐Rak; Park, Gyung‐Min; Ahn, Jung‐Min; Kim, Won‐Jang; Lee, Jong‐Young; Park, Duk‐Woo; Lee, Seung-Whan; Kim, Young‐Hak; Lee, Cheol Whan; Mintz, Gary S.; Park, Seong-Wook; Park, Seung‐Jung

doi:10.1016/j.amjcard.2013.01.288

Cited by 75 publications

(50 citation statements)

References 18 publications

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“…From November 2010 to February 2013, 463 patients underwent PCI for de novo native coronary artery lesions. Of these, 319 patients who underwent (1) PCI with everolimus-eluting stent (Xience V/Xience Prime; Abbott Vascular, Santa Clara, CA), (2) OCT assessment at post PCI, and (3) scheduled follow-up angiography 9 to 12 months after the index procedure were selected for analysis ( Figure 1). The selected patients had 382 stent-treated lesions.…”

Section: Study Populations and Pci Proceduresmentioning

confidence: 99%

“…8 Major factors implicated in SER are inadequate stent implantation procedure and residual disease in the stent edge segments. [1][2][3]9 An angiography trial revealed that the longitudinal geographic miss (diseased or balloon-injured segment not covered by stent) was associated with increased risk of target vessel revascularization mostly because of focal restenosis at the stent edges. 9 Several intravascular ultrasound studies disclosed that a larger plaque burden, smaller lumen in the edge segment at post PCI, and greater step-up index (ratio of stent border to reference minimum lumen area) were important risk factors for SER.…”

Section: Conventional Risk Factors For Sermentioning

confidence: 99%

“…Previous intravascular ultrasound studies have disclosed that greater residual plaque burden and stent overexpansion are associated with SER. 2,3 Optical coherence tomography (OCT) is a high-resolution (10-20 μm) intravascular imaging technique that uses near-infrared light to create images. An excellent contrast between lumen and vessel wall in OCT allows accurate lumen measurements.…”

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confidence: 99%

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Optical Coherence Tomography Predictors for Edge Restenosis After Everolimus-Eluting Stent Implantation

Ino

Kubo

Matsuo

et al. 2016

Circ: Cardiovascular Interventions

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P ercutaneous coronary intervention (PCI) is a common and established therapy for coronary artery disease. Drugeluting stents have been shown to reduce neointimal hyperplasia and restenosis in stent segments. However, restenosis in reference segments adjacent to the proximal and distal border of the stent (so-called stent edge restenosis [SER]) remains a potential limitation of drug-eluting stents. 1Stenting from normal to normal is effective to minimize SER. However, the reference segments are rarely normal. Especially in diffuse disease, it is difficult to determine appropriate plaque-free reference segments for stent landing. Previous intravascular ultrasound studies have disclosed that greater residual plaque burden and stent overexpansion are associated with SER. 2,3 Optical coherence tomography (OCT) is a high-resolution (10-20 μm) intravascular imaging technique that uses near-infrared light to create images. An excellent contrast between lumen and vessel wall in OCT allows accurate lumen measurements. 4 Tissue characterization by OCT enables us to identify 3 types of coronary plaques such as lipid, fibrous, and fibrocalcific. 5 In addition, OCT has a high sensitivity for detection of suboptimal stent findings such as intrastent tissue protrusion, incomplete stent apposition, stent edge dissection, and intrastent thrombus. 4 Recently, OCT is becoming increasingly widespread as a clinical tool to guide PCI. The aim of this study was to determine OCT predictors for angiographic SER after everolimus-eluting stent implantation.Background-Stent edge restenosis (SER) remains a potential limitation of drug-eluting stents. The aim of this study was to determine optical coherence tomography (OCT) predictors for angiographic late SER after everolimus-eluting stent implantation. Methods and Results-We retrospectively analyzed 319 patients who underwent OCT immediately after everolimus-eluting stent implantation and scheduled 9-to 12-month follow-up angiography. The binary angiographic SER rate was 10% (32/319) in the patients, 8.4% (32/382) in lesions, and 4.4% (33/744) in stent edge segments. In the stent edge segments at post stenting, OCT-derived lipidic plaque (61% versus 20%; P<0.001) was more often observed in the SER group, and OCT-measured minimum lumen area (4.13±2.61 versus 5.58±2.46 mm 2 ; P=0.001) was significantly smaller in the SER group compared with the non-SER group. Multivariate analysis identified lipidic plaque (odds ratio: 5.99; 95% confidence interval: 2.89-12.81; P<0.001) and minimum lumen area (odds ratio: 0.64; 95% confidence interval: 0.42-0.96; P=0.029) as independent predictors of binary SER. Receiver-operating characteristic analysis demonstrated that lipid arc of 185° (sensitivity: 71%; specificity: 72%; area under the curve: 0.761) and minimum lumen area of 4.10 mm 2 (sensitivity: 67%; specificity: 77%; area under the curve: 0.787) were optimal cutoff values for predicting ischemiadriven SER. Conclusions-The present OCT study demonstrated that lipidic plaque and minimum lumen area in t...

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Section: Study Populations and Pci Proceduresmentioning

confidence: 99%

Section: Conventional Risk Factors For Sermentioning

confidence: 99%

mentioning

confidence: 99%

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Optical Coherence Tomography Predictors for Edge Restenosis After Everolimus-Eluting Stent Implantation

Ino

Kubo

Matsuo

et al. 2016

Circ: Cardiovascular Interventions

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“…The first generation DES have also been associated with the increased rates of very late (>1 year) stent thrombosis (4)(5). The introduction of new generation DES has further reduced the rates of adverse clinical events and supports the opinion that the preferred strategy is to cover the entire lesion, because the residual plaque burden is known to be a predictor for stent edge restenosis (6). The large study comparing the first and new generation DES found the association between the stent length and long-term clinical outcomes only in the first generation DES group, concluding that the stent length might not be associated with clinical outcomes in the new generation DES era (7).…”

Section: Introductionmentioning

confidence: 98%

FFR guided PCI on long coronary lesions: 2-year clinical results with 2nd or newer generation DES

Baranauskas

Bajoras

Budrys

et al. 2016

AML

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Background. Despite improvements in drug-eluting stent (DES) technology, treatment strategies for long coronary artery lesions remain a controversial issue. The aim of our study was to evaluate the long-term clinical results after FFR guided PCI on long coronary lesions.Materials and methods. A total of 74 consecutive patients with significant (mean FFR 0.61 ± 0.11) coronary artery lesions ≥30 mm in length were included in the prospective study. All patients were treated with FFR guided PCI implanting newer generation Biolimus, Everolimus or Zotarolimus eluting stents. Clinical endpoints -target vessel revascularization (TVR) and major adverse cardiac events (MACE) -were recorded at 1 and 2 years.Results. 100% angiographic procedure success was achieved, the mean post procedural FFR was 0.88 ± 0.06. At 2-year follow-up, 6 (8.1%) patients had ischemia driven TVR, all within the first 12 months. There were no target vessel related acute coronary syndromes and definite stent thromboses in the study group. At 2 years, the total MACE rate was 29.7%. There was a trend towards a higher TVR rate in patients with overlapping DES vs single DES implanted (9.6 vs 4.5%, p = 0.6). On regression analysis, the total stent length had no influence on the TVR rate.Conclusions. At 2 years after stenting long coronary lesions with newer generation DES the TVR rate was 8.1%, which is acceptable in the high cardiovascular risk population with diffuse coronary artery disease. The total stent length did not affect the long-term clinical outcomes.

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“…The process of drug eluting stent (DES) struts thinning that occurred in the last year with the introduction of cobalt-chromium devices has been of utmost importance to significantly reduce the incidence of stent thrombosis and restenosis [1,2]. Yet, suboptimal stent positioning represents a trigger for acute events even after deployment of scaffolds with optimal design and a valid polymerdrug combination [3][4][5][6][7].…”

Section: Introductionmentioning

confidence: 99%

Mechanical Causes of Stent Failure: OCT Insights

Gatto¹,

Ramazzotti²,

Micari³

et al. 2017

Interv Cardiol J

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Intravascular Ultrasound Predictors for Edge Restenosis After Newer Generation Drug-Eluting Stent Implantation

Cited by 75 publications

References 18 publications

Optical Coherence Tomography Predictors for Edge Restenosis After Everolimus-Eluting Stent Implantation

Optical Coherence Tomography Predictors for Edge Restenosis After Everolimus-Eluting Stent Implantation

FFR guided PCI on long coronary lesions: 2-year clinical results with 2nd or newer generation DES

Mechanical Causes of Stent Failure: OCT Insights

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