The impact of angulated lesions on angiographic late loss in patients with drug-eluting stent implantation

Abstract

Angulated lesion was classified in moderate risk lesion subset in PTCA guidelines 2000, because angulated lesion has been associated with abrupt closure or myocardial injury. We compared angiographic late loss at 6-9 months in bending lesions to that in non-bending lesion. This study included 227 lesions (de nowo) who were implanted Cypher Sirolimus-eluting stent (SES). There were 52 bending lesions (22.9%) and 175 non-bending lesions (77.1%). There were no significant differences in age and complicated disease between the two groups except the higher prevalence of prior cerebral infarction in the bending lesion group. There were more eccentric lesions in the bending group than in the non-bending group (43.7% vs. 63.5%, p=0.01). Follow-up MLD (in stent) was not significantly different between the two groups (p=NS) and the angiographic restenosis rate was 23.6% in bending lesions and 17.8% in non-bending lesions (p=NS). In-stent and in-segment late loss were similar between the two groups (0.09+/-0.58 vs. 0.18+/-0.64, p=NS, 0.06+/-0.50 vs. 0.09+/-0.65, p=NS). No stent fracture was observed by angiography and IVUS in this study. Follow-up MLD (in stent) was not significantly different between the two groups (p=NS) and the angiographic restenosis rate was 23.6% in bending lesions and 17.8% in non-bending lesions (p=NS). Lesion bending is not associated with long-term angiographic late loss after DES implantation. DES may reduce clinical events in patients with bending lesion.

Angiographic Geometric Changes of the Lumen Arterial Wall After Bioresorbable Vascular Scaffolds and Metallic Platform Stents at 1-Year Follow-Up

“…A pre-treatment angulation Ն33.5°was found as an independent predictor of restenosis at 10 months of follow-up (8). However, with the use of SES, to date no study has been able to relate the artery curvature/angulation before implantation with a greater neointimal response or higher risk of restenosis (7,10,23). However, most of these studies are limited to clinical outcomes at midterm follow-up.…”

“…Conversely, sirolimus-eluting stents (SES) have been demonstrated to avoid the relationship between low WSS and a higher neointimal response at 6 months (7). As a result, some clinical studies using first-generation SES showed no relationship between angulated lesions and angiographic restenosis at 9 months (10,11). It is still unknown whether the progressive loss of angiographic minimal lumen diameter (MLD) experienced by the SES at long-term follow-up can modify the relationships among artery bend, curvature, and angulation with stent restenosis (12).…”

Associations between lipid profiles and MACE in hemodialysis patients with percutaneous coronary intervention: From the FU-Registry

“…QCA data were not available for all of the lesions because (1) follow-up CAG was not performed both in our hospital and two other collaborating hospitals, or (2) lesions for QCA analyses were randomly selected during the period when we started to establish a QCA analysis system (between 2003 and 2005). Quantitative and qualitative analyses were performed using CMS-GFT (MEDES, Amsterdam, The Netherlands) at Fukuoka University, which was the core laboratory for the study, as described previously [13][14][15][16][17]. An analysis was performed for angiograms obtained at pre-procedural and post-procedural follow-up.…”

Three-dimensional evaluation of the spatial morphology of stented coronary artery segments in relation to restenosis

“…In human investigation the straightening effect of the stent implantation was identified as a predictor of restenosis [3, 4]. However, Fukuda later concluded that the lesion angulation was not associated with restenosis following early generation sirolimus-eluted stent implantation [13]. Recently, Gomez-Lara et al examined the role of bendings, vessel curvature and angulation in target vessel revascularisation with the comparison of two second-generation DES platforms.…”