Optical Coherence Tomography of De Novo Lesions and In-Stent Restenosis in Coronary Saphenous Vein Grafts (OCTOPUS Study)

Abstract

Background:The OCTOPUS registry prospectively evaluates the procedural and long-term outcomes of saphenous vein graft (SVG) PCI. The current study assessed the morphology of de novo lesions and in-stent restenosis (ISR) in patients undergoing PCI of SVG. Methods and Results:Optical coherence tomography (OCT) of SVG lesions in consecutive patients presenting with stable CAD and ACS was carried out. Thirty-nine patients (32 de novo and 10 ISR lesions) were included in the registry. ISR occurred in 5 BMS and 5 DES. There were no differences in the presence of plaque rupture and thrombus between de novo lesions and ISR. Lipid-rich tissue was identified in both de novo lesions and in ISR (75% vs. 50%, P=0.071) with a higher prevalence in BMS than in DES (23% vs. 7.5%; P=0.048). Calcific de novo lesions were detected in older grafts as compared with non-calcific atheromas (159±57 vs. 90±62 months after CABG, P=0.001). Heterogeneous neointima was found only in ISR (70% vs. 0, P<0.001) and was observed with similar frequency in both BMS and DES (24% vs. 30%, P=0.657). ISR was detected earlier in DES than BMS (median, 50 months; IQR, 18-96 months vs. 27 months; IQR, 13-29 months, P<0.001). Conclusions:OCT-based characteristics of de novo and ISR lesions in SVG were similar except for heterogeneous tissue, which was observed only in ISR. (Circ J 2016; 80: 1804 -1811

Multimodality intravascular imaging of bioresorbable vascular scaffolds implanted in vein grafts

“…Our study showed that BVS characterized stable scaffold concentricity up to 48 months after the implantation. It may be explained by the fact that vein graft lesions are less calcified and thus an appropriate scaffold shape was much more easily achieved as compared to native coronary arteries [22, 23]. Additionally, the stable BVS shape may explain the lack of malapposition during the follow-up, which in line with the animal model observations [24], but in contrast to human studies.…”

Ten‐year outcomes after percutaneous coronary intervention of in‐stent restenosis in saphenous vein grafts

“…Furthermore, PCI of SVG is accompanied by high rates of restenosis, 8,9 an independent predictor of long‐time survival 5 . Because of low shear stress and a high thrombogenic state, SVG ISR develop faster than de novo lesions in SVG 25 . However, elapsed time from stent implantation to ISR does not seem to differ between SVG and native vessel lesions, 26 which implicates similar pathophysiological processes causing ISR in SVG and native vessels 25 .…”

“…Because of low shear stress and a high thrombogenic state, SVG ISR develop faster than de novo lesions in SVG 25 . However, elapsed time from stent implantation to ISR does not seem to differ between SVG and native vessel lesions, 26 which implicates similar pathophysiological processes causing ISR in SVG and native vessels 25 . Taking these considerations into account, ISR located in SVG constitute a clinically significant challenge in interventional cardiology.…”

Saphenous graft atherosclerosis as assessed by optical coherence tomography data for stenotic and non-stenotic lesions from the OCTOPUS registry

“…Twenty-nine patients hospitalized in the Upper Silesia Medical Center between June 2013 and March 2016 were included in the OCTOPUS registry [ 20 , 21 ]. Each patient gave informed written content, and the study complied with the Declaration of Helsinki and was accepted by the local ethical committee.…”