Intravascular ultrasound assessment of the incidence and predictors of edge dissections after drug-eluting stent implantation.
OBJECTIVE
We used intravascular ultrasound (IVUS) to assess incidence, predictors, morphology, and angiographic findings of edge dissections after drug-eluting stent (DES) implantation.


BACKGROUND
DES implantation strategies differ compared with bare-metal stenting; coronary dissections after DES implantation have not been well studied.


METHODS
We studied 887 patients with 1,045 non-in-stent restenosis lesions in 977 native arteries undergoing DES implantation with IVUS imaging.


RESULTS
Eighty-two dissections were detected; 51.2% (42 of 82) involved the proximal and 48.8% (40 of 82) the distal stent edge. Residual plaque area (8.0 +/- 4.3 mm(2) vs. 5.2 +/- 3.0 mm(2), p < 0.0001); plaque burden (52.2 +/- 11.7% vs. 36.2 +/- 15.3%, p < 0.0001); plaque eccentricity (8.4 +/- 5.5 vs. 4.0 +/- 3.4, p < 0.0001); and stent edge symmetry (1.2 +/- 0.1 vs. 1.1 +/- 0.1, p = 0.02) were larger; plaque burden > or =50% was more frequent (62.0% vs. 17.2%, p < 0.0001); calcium deposits (52.1% vs. 35.2%, p = 0.03) more common; and lumen-to-stent-edge-area ratio (0.9 +/- 0.2 vs. 1.0 +/- 0.2, p < 0.0001) was smaller in the edge dissection group compared with the nondissection group. Intramural hematomas occurred in 34.1% (28 of 82) of dissections. When compared with nonhematoma dissections, residual plaque and media area (6.4 +/- 2.5 mm(2) vs. 8.9 +/- 4.6 mm(2), p = 0.04) was smaller, and stent edges less asymmetric (1.1 +/- 0.1 vs. 1.2 +/- 0.1, p = 0.009) in the dissection with hematoma group. Independent predictors of any stent edge dissection were residual plaque eccentricity (odds ratio [OR]: 1.4, p = 0.02), lumen-to-stent-edge-area ratio (OR: 0.0, p = 0.007), and stent edge symmetry (OR: 1.2, p = 0.02 for each 0.01 increase).


CONCLUSIONS
IVUS identified edge dissections after 9.2% of DES implantations. Residual plaque eccentricity, lumen-to-stent-edge-area ratio, and stent edge symmetry predicted coronary stent edge dissections. Dissections in less diseased reference segments more often evolved into an intramural hematoma.
Liu
Xuebo
X
Columbia University Medical Center and Cardiovascular Research Foundation, New York, New York, USA.
Tsujita
Kenichi
K
Maehara
Akiko
A
Mintz
Gary S
GS
Weisz
Giora
G
Dangas
George D
GD
Lansky
Alexandra J
AJ
Kreps
Edward M
EM
Rabbani
LeRoy E
LE
Collins
Michael
M
Stone
Gregg W
GW
Moses
Jeffrey W
JW
Mehran
Roxana
R
Leon
Martin B
MB
D000368:Aged; D000784:Aortic Dissection / Q000000981:diagnostic imaging* / Q000209:etiology; D015906:Angioplasty, Balloon, Coronary / Q000009:adverse effects / Q000295:instrumentation*; D003323:Coronary Aneurysm / Q000000981:diagnostic imaging* / Q000209:etiology; D017023:Coronary Angiography; D023921:Coronary Stenosis / Q000000981:diagnostic imaging / Q000628:therapy*; D054855:Drug-Eluting Stents; D005260:Female; D006406:Hematoma / Q000000981:diagnostic imaging* / Q000209:etiology; D006801:Humans; D015994:Incidence; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D016017:Odds Ratio; D018570:Risk Assessment; D012307:Risk Factors; D016896:Treatment Outcome; D018084:Ultrasonography, Interventional