Retrospective analysis of OCT on MB characteristics and 1-year follow-up of the ISR incidence after the DES implantation in patients with MB

Abstract

We used optical coherence tomography (OCT) to analyze the "half-moon" like phenomenon and its characteristics and observe 1-year follow-up of the in-stent restenosis (ISR) incidence after the drug eluted stent (DES) implantation in patients with the myocardial bridge (MB). Patients were retrospectively analyzed from January 2013 to December 2019. We used OCT to check 45 patients with MB and found a visible muscle layer (VML) around the vessel adventitia with the same or high density compared to the vessel media layer. There was not any significant difference in maximal thickness, maximal arch, and total length between the half-moon layer and the visible muscle layer groups (p > 0.05). Maximal thickness, arch, and total length of the half-moon layer were significantly positively related to VML, respectively (r = 0.962, 0.985, 0.742, p < 0.01). Of these 626 patients with MB seen by OCT, only 300 could be checked out by coronary angiography (CAG). Besides, the larger the thickness and arch of the VML around the vessel adventitia, the more severe the MB in these patients (p < 0.05). After the OCT use, there was no coronary perforation in these patients with MB covered with DES. After 1-year follow-up, ISR in MB covered with DES showed a notable difference among no MB, mild MB, moderate MB, and severe MB groups (p < 0.05), and ISR in DES aggravated with the MB severity. However, ISR in MB with and without covered with DES had no significant difference among the 4 groups (p > 0.05). OCT could evaluate MB characteristics accurately compared to IVUS and had a higher rate of detecting MB than CAG. Moreover, it is safe and effective to guide DES covering the mild MB segment in patients with severe coronary lesions detected by the OCT.

Biochemical, coronary angiographic and echocardiographic parameters in inferior acute myocardial infarction with right ventricle injury

“…В каждом отдельном клиническом случае определяется индивидуальная анатомия коронарного русла, сформированная вследствие врожденных и приобретенных факторов. Существуют разные мнения относительно мышечных мостиков и фистул коронарных артерий: одни считают их врожденной патологией, другие − особенностью строения коронарного русла, то есть нормой [14]. Результаты нашего исследования позволяют предположить увеличение риска поражения ПЖ при окклюзии ПКА в присутствии мышечного мостика или фистулы ПМЖА и при малом диаметре ОА.…”

Comprehensive functional and anatomic assessment of myocardial bridging: Unlocking the Gordian Knot

“…Some studies proposed the main OCT features of MB, describing a heterogeneous fusiform band with sharp borders and low/intermediate-intensity signal, similar to tunica media, surrounding the vessel adventitia. Obviously, the fusiform band detected by OCT, corresponds to the "half-moon" sign using IVUS (63)(64)(65)(66)(67). OCT provides the detection and anatomic characterization of atherosclerotic lesions proximal to MB too (64).…”

“…However, PCI with stenting in MB patients may lead to a high rate of complications such as instent restenosis (ISR), very late stent thrombosis, and coronary perforation, due to the sustained stress over time within the intramural tract. These complications were described mainly in studies using bare-metal stent (BMS) and first-generation drug eluting stent (DES) (8,63,(93)(94)(95)(96). Probably, the use of second-generation DES or future bioabsorbable scaffolds may potentially limit these complications (13).…”

“…Furthermore, in cases of ACS and concomitant presence of MB, OCT helps in differentiating between different pathophysiological subtypes, such as plaque rupture/erosion, thrombosis or spontaneous coronary artery dissection (SCAD) ( 30 ). Finally, despite weak evidence, the use of OCT might help in guiding percutaneous revascularization, with the aim of minimizing peri- and post-procedural complications during stent implantation in a MB segment ( 63 ).…”

“…Furthermore, the use of intracoronary imaging tools may provide accurate information about MB sizing, guiding the percutaneous treatment. In this regard, a recent retrospective study showed that the guidance of OCT limited the incidence of perforation and ISR in the MB segment covered with DES ( 63 ).…”