title: Incidence, predictors, morphological characteristics, and clinical outcomes of stent edge dissections detected by optical coherence tomography.
abstract: OBJECTIVE
  This study sought to investigate the frequency, predictors, and detailed qualitative and quantitative assessment of optical coherence tomography (OCT)-detected stent edge dissections. Its impact on subsequent management and clinical outcomes were also investigated.
  
  
  BACKGROUND
  OCT is a high-resolution imaging modality that can lead to more frequent recognition and accurate assessment of vascular injuries during percutaneous coronary intervention (PCI).
  
  
  METHODS
  From September 2010 to June 2011, all patients with OCT post-PCI were enrolled. Edge dissections were defined as disruptions of the arterial lumen surface in both the 5-mm distal and proximal stent edges. Qualitative and quantitative analyses of all edges were performed at 0.2-mm intervals.
  
  
  RESULTS
  In total, 395 edges (249 lesions in 230 patients) were analyzed. The overall incidence of OCT-detected edge dissection was 37.8%, and most (84%) were not apparent on angiography. Independent predictors for OCT-detected dissections were presence of atherosclerotic plaque at stent edges, calcification angle, minimum fibrous cap thickness, thin-cap fibroatheromas, stent/lumen eccentricity, and vessel overstretching. Mean dissection length measured 2.04 ± 1.60 mm, 96.2% appeared as flaps, and 52.8% extended beyond the intima/atheroma layer. Additional stenting was performed in 22.6% of all dissections, which were longer, had bigger dimensions, and promoted deeper vascular injury. The 12-month major adverse cardiac event rate was similar between patients with (7.95%) and without (5.69%, p = 0.581) dissections.
  
  
  CONCLUSIONS
  High rates of stent edge dissections were detected by OCT, usually related to the presence of atherosclerosis at stent edges and to PCI technique. Detailed OCT assessment of dissection severity was possible and affected the subsequent management of this complication. Non-flow-limiting, small, and superficial dissections left untreated proved benign.
authors.affiliation: Division of Cardiology, Harrington Heart & Vascular Institute, University Hospitals Case Medical Center, Case Western Reserve School of Medicine, Cleveland, Ohio 44106, USA.
authors.forename: Daniel
authors.initials: D
authors.lastname: Chamié
authors.forename: Hiram G
authors.initials: HG
authors.lastname: Bezerra
authors.forename: Guilherme F
authors.initials: GF
authors.lastname: Attizzani
authors.forename: Hirosada
authors.initials: H
authors.lastname: Yamamoto
authors.forename: Tomoaki
authors.initials: T
authors.lastname: Kanaya
authors.forename: Gregory T
authors.initials: GT
authors.lastname: Stefano
authors.forename: Yusuke
authors.initials: Y
authors.lastname: Fujino
authors.forename: Emile
authors.initials: E
authors.lastname: Mehanna
authors.forename: Wei
authors.initials: W
authors.lastname: Wang
authors.forename: Ahmad
authors.initials: A
authors.lastname: Abdul-Aziz
authors.forename: Matthew
authors.initials: M
authors.lastname: Dias
authors.forename: Daniel I
authors.initials: DI
authors.lastname: Simon
authors.forename: Marco A
authors.initials: MA
authors.lastname: Costa
mesh_terms: D000368:Aged; D015906:Angioplasty, Balloon, Coronary / Q000009:adverse effects* / Q000295:instrumentation*; D017023:Coronary Angiography; D003324:Coronary Artery Disease / Q000175:diagnosis / Q000628:therapy*; D003331:Coronary Vessels / Q000293:injuries* / Q000473:pathology*; D005260:Female; D006335:Heart Injuries / Q000453:epidemiology / Q000473:pathology* / Q000628:therapy; D006801:Humans; D015994:Incidence; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D016017:Odds Ratio; D011237:Predictive Value of Tests; D012307:Risk Factors; D015607:Stents; D013997:Time Factors; D041623:Tomography, Optical Coherence; D016896:Treatment Outcome; D057772:Vascular System Injuries / Q000453:epidemiology / Q000473:pathology* / Q000628:therapy
keywords: FC; IVUS; MACE; MI; OCT; OR; PCI; TCFA; coronary dissection; fibrous cap; intravascular ultrasound; major adverse cardiac event(s); myocardial infarction; odds ratio; optical coherence tomography; percutaneous coronary intervention; stent; thin-cap fibroatheroma