Natural history of optical coherence tomography-detected non-flow-limiting edge dissections following drug-eluting stent implantation.
OBJECTIVE
Angiographic evidence of edge dissections has been associated with a risk of early stent thrombosis. Optical coherence tomography (OCT) is a high-resolution technology detecting a greater number of edge dissections--particularly non-flow-limiting--compared to angiography. Their natural history and clinical implications remain unclear. The objectives of the present study were to assess the morphology, healing response, and clinical outcomes of OCT-detected edge dissections using serial OCT imaging at baseline and at one year following drug-eluting stent (DES) implantation.


RESULTS
Edge dissections were defined as disruptions of the luminal surface in the 5 mm segments proximal and distal to the stent, and categorised as flaps, cavities, double-lumen dissections or fissures. Qualitative and quantitative OCT analyses were performed every 0.5 mm at baseline and one year, and clinical outcomes were assessed. Sixty-three lesions (57 patients) were studied with OCT at baseline and one-year follow-up. Twenty-two non-flow-limiting edge dissections in 21 lesions (20 patients) were identified by OCT; only two (9%) were angiographically visible. Flaps were found in 96% of cases. The median longitudinal dissection length was 2.9 mm (interquartile range [IQR] 1.6-4.2 mm), whereas the circumferential and axial extensions amounted to 1.2 mm (IQR: 0.9-1.7 mm) and 0.6 mm (IQR: 0.4-0.7 mm), respectively. Dissections extended into the media and adventitia in seven (33%) and four (20%) cases, respectively. Eighteen (82%) OCT-detected edge dissections were also evaluated with intravascular ultrasound which identified nine (50%) of these OCT-detected dissections. No stent thrombosis or target lesion revascularisation occurred up to one year. At follow-up, 20 (90%) edge dissections were completely healed on OCT. The two cases exhibiting persistent dissection had the longest flaps (2.81 mm and 2.42 mm) at baseline.


CONCLUSIONS
OCT-detected edge dissections which are angiographically silent in the majority of cases are not associated with acute stent thrombosis or restenosis up to one-year follow-up.
Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark.
Maria D
MD
Radu
Lorenz
L
Räber
Jungho
J
Heo
Bill D
BD
Gogas
Erik
E
Jørgensen
Henning
H
Kelbæk
Takashi
T
Muramatsu
Vasim
V
Farooq
Steffen
S
Helqvist
Hector M
HM
Garcia-Garcia
Stephan
S
Windecker
Kari
K
Saunamäki
Patrick W
PW
Serruys
D000368:Aged; D015906:Angioplasty, Balloon, Coronary; D023903:Coronary Restenosis / Q000209:etiology; D003331:Coronary Vessels / Q000473:pathology* / Q000601:surgery*; D054855:Drug-Eluting Stents / Q000009:adverse effects*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D013927:Thrombosis / Q000209:etiology; D041623:Tomography, Optical Coherence / Q000379:methods; D016896:Treatment Outcome