New Volumetric Analysis Method for Stent Expansion and its Correlation With Final Fractional Flow Reserve and Clinical Outcome

Objectives To assess the clinical significance of a novel optical coherence tomography (OCT)‐derived volumetric parameter of stent expansion by comparing it with the conventional parameters in real‐world practice. Background The clinical significance of novel parameters in real‐world practice including longer and smaller stents remains to be elucidated. Methods A total of 226 de novo lesion treated with drug‐eluting stents in 208 consecutive patients were enrolled. Stent expansion was retrospectively assessed on the final OCT images after stent implantation. The novel parameter was the minimum expansion index (MEI) calculated using a novel algorithm that yields the ideal lumen area in each frame by taking into account vessel tapering. The device‐oriented clinical end point (DoCE) included cardiac death, target vessel‐related myocardial infarction, ischemia‐driven target lesion revascularization. Results The MEI in the lesions with a DoCE (n = 22) at 2 years and cases without a DoCE (n = 204) was 64.3 ± 12.0% and 78.5 ± 14.6%, respectively (p < .001). In the receiver operating characteristic curve analyses, the areas under the curve for the MEI (0.787; p < .001) were larger than that for %stent expansion (0.718; p = .001) and minimum stent area (0.664; p = .004) in predicting the DoCE. The best cutoff of MEI for predicting the DoCE was 74.0. Conclusions The novel MEI was better than the conventional %stent expansion and minimum stent area for predicting DoCE.

Section: Discussionmentioning

confidence: 99%

Section: Methodsmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 95%

Section: Introductionmentioning

confidence: 99%

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Novel volumetric analysis for stent expansion after drug‐eluting stent implantation: An optical coherence tomography study

Katsura

Minami

Kato

et al. 2020

“…A major malapposition was defined when the strut-lumen distance was higher than 200 μm. 5 An edge dissection was defined as the disruption of the vessel luminal surface with a visible flap at the stent edge or within 5 mm of the proximal and distal reference segments. In-stent dissections were also evaluated.…”

Section: Oct Image Analysismentioning

confidence: 99%

Characteristics of abnormal post‐stent optical coherence tomography findings in hemodialysis patients

Matsuhiro

Matsunaga‐Lee

Nakamura

et al. 2019

Self Cite

Aim Clinical outcomes after percutaneous coronary intervention (PCI) in hemodialysis (HD) patients are significantly worse than those in non‐HD patients. Optical coherence tomography (OCT) is a high resolution imaging modality and provides a detailed assessment of post‐interventional abnormal findings that influence worse clinical outcomes. However, little is known about the abnormal post‐stent OCT findings in HD patients. Therefore, in this study, we compared the abnormal post‐stent OCT findings between HD and non‐HD patients. Methods One hundred thirty‐nine consecutive OCT guided PCI (21 lesions in HD patients and 118 lesions in non‐HD patients) were enrolled. We compared the post‐stent OCT findings, including the edge dissections, under expansion index (minimum stent area/mean reference area), and stent eccentricity index (minimum stent diameter/maximum stent diameter) between HD and non‐HD patients. We also compared the device‐oriented clinical events (DoCEs) at 8 months of follow up. Results There was a significantly higher prevalence of distal edge dissections (16.7% vs. 2.8%, P = 0.011) in HD patients. HD patients had a significantly lower under expansion index (0.76 ± 0.21 vs. 0.85 ± 0.14, P = 0.029) and stent eccentricity index (0.82 ± 0.09 vs. 0.88 ± 0.18, P = 0.018). The cumulative rate of DoCEs was significantly higher in the HD patients (23.8% vs. 5.2%, P = 0.013). Conclusions A higher prevalence of distal edge dissections, under expansion and stent eccentricity were detected by the detailed OCT findings in HD patients.

Comparison of 6‐month vascular healing response after bioresorbable polymer versus durable polymer drug‐eluting stent implantation in patients with acute coronary syndromes: A randomized serial optical coherence tomography study

Noguchi

Dohi

Okazaki

et al. 2021

Objectives This study was conducted to use optical coherence tomography (OCT) to compare vascular healing between bioresorbable polymer (BP) and durable polymer (DP) everolimus‐eluting stents (EES) in patients with acute coronary syndromes (ACS). Background Whether BP‐EES induce better vascular healing compared to contemporary DP‐EES remains controversial, especially for ACS. Methods In this prospective, randomized, non‐inferiority trial, we used OCT to compare 6‐month vascular healing in patients with ACS randomized to BP versus DP‐EES: percent strut coverage (primary endpoint, non‐inferiority margin of 2.0%) and neointimal thickness and percent neointimal hyperplasia (NIH) volume. As an exploratory analysis, morphological factors related to the endpoints and the effect of underlying lipidic plaque on stent healing were evaluated. Results A total of 104 patients with ACS were randomly assigned to BP‐EES (n = 52) versus DP‐EES (n = 52). Of these, 86 patients (40 BP‐EES and 46 DP‐EES) were included in the final OCT analyses. Six‐month percent strut coverage of BP‐EES (83.6 ± 11.4%) was not non‐inferior compared to those of DP‐EES (81.6 ± 13.9%), difference 2.0% (lower 95% confidence interval‐2.6%), pnon‐inferiority = 0.07. There were no differences in neointimal thickness 70.0 ± 33.9 μm versus 67.2 ± 33.9 μm, p = 0.71; and percent NIH volume 7.5 ± 4.7% versus 7.3 ± 5.3%, p = 0.85. By multivariable linear regression analysis, stent type was not associated with percent strut coverage or percent NIH volume; however, percent baseline embedded struts or stent expansion was positively associated with percent NIH volume. Greater NIH volume was observed in lipidic compared with non‐lipidic segments (8.7 ± 5.6% vs. 6.1 ± 5.2%, p = 0.005). Conclusions Six‐month strut coverage of BP‐EES was not non‐inferior compared to those of DP‐EES in ACS patients. Good stent apposition and expansion were independently associated with better vascular healing.