title: Serial assessment of vessel interactions after drug-eluting stent implantation in unprotected distal left main coronary artery disease using frequency-domain optical coherence tomography.
abstract: OBJECTIVE
  This study sought to assess stent-vessel interactions after drug-eluting stent (DES) implantation in unprotected left main coronary artery (ULM) by frequency-domain optical coherence tomography (FD-OCT).
  
  
  BACKGROUND
  Percutaneous coronary intervention using DES in ULM has been increasingly performed in routine practice. Recently, FD-OCT assessments of DES-vessel interactions have been used as surrogates for DES safety; however, there are no FD-OCT studies in ULM.
  
  
  METHODS
  We prospectively enrolled 33 consecutive patients with ULM disease treated with sirolimus- (n = 11) and everolimus-eluting stents (n = 22). FD-OCT assessments were performed post-percutaneous coronary intervention and at 9-month follow-up. Three different segments of ULM were compared: distal (DIS), bifurcation (BIF), and ostial-body (BODY). The primary endpoints were percentages of uncovered and malapposed struts at 9-month follow-up, and the secondary endpoint was neointimal hyperplasia area.
  
  
  RESULTS
  We analyzed 25,873 stent struts. Significant differences were demonstrated for percentage of uncovered struts (3.4%, 11.7%, and 18.7%, respectively for DIS, BIF, and BODY; p < 0.05 for all the comparisons). Malapposition was also more common in BODY (5.3%) than in DIS (0.6%) and BIF (2.0%) segments (p < 0.05 for BODY vs. DIS, and BODY vs. BIF). Equivalent neointimal hyperplasia areas were demonstrated in all segments. Acute malapposition rates led to different patterns of DES-vessel interactions at 9-month follow-up.
  
  
  CONCLUSIONS
  Distinct patterns of DES-vessel interactions were demonstrated in different segments of ULM. Acute stent strut malapposition affects these findings.
authors.affiliation: Harrington Heart and Vascular Institute, University Hospitals Case Medical Center, Case Western Reserve University, Cleveland, Ohio; Department of Cardiology, New Tokyo Hospital, Chiba, Japan.
authors.forename: Yusuke
authors.initials: Y
authors.lastname: Fujino
authors.forename: Guilherme F
authors.initials: GF
authors.lastname: Attizzani
authors.forename: Hiram G
authors.initials: HG
authors.lastname: Bezerra
authors.forename: Wei
authors.initials: W
authors.lastname: Wang
authors.forename: Satoko
authors.initials: S
authors.lastname: Tahara
authors.forename: Hirosada
authors.initials: H
authors.lastname: Yamamoto
authors.forename: Daniel
authors.initials: D
authors.lastname: Chamie
authors.forename: Tomoaki
authors.initials: T
authors.lastname: Kanaya
authors.forename: Emile
authors.initials: E
authors.lastname: Mehanna
authors.forename: Kensuke
authors.initials: K
authors.lastname: Takagi
authors.forename: Sunao
authors.initials: S
authors.lastname: Nakamura
authors.forename: Marco A
authors.initials: MA
authors.lastname: Costa
mesh_terms: D000368:Aged; D002317:Cardiovascular Agents / Q000008:administration & dosage; D003324:Coronary Artery Disease / Q000175:diagnosis / Q000628:therapy*; D003331:Coronary Vessels / Q000187:drug effects / Q000473:pathology*; D054855:Drug-Eluting Stents; D000068338:Everolimus; D005260:Female; D006801:Humans; D006965:Hyperplasia; D008297:Male; D008875:Middle Aged; D058426:Neointima; D062645:Percutaneous Coronary Intervention / Q000009:adverse effects / Q000295:instrumentation*; D011237:Predictive Value of Tests; D011446:Prospective Studies; D011474:Prosthesis Design; D020123:Sirolimus / Q000008:administration & dosage / Q000031:analogs & derivatives; D013997:Time Factors; D041623:Tomography, Optical Coherence; D016896:Treatment Outcome
chemical_list: D002317:Cardiovascular Agents; D000068338:Everolimus; D020123:Sirolimus
keywords: BIF; BODY; DES; DIS; EES; FD-OCT; NIH; SES; SIT; ST; TIMI; Thrombolysis In Myocardial Infarction; ULM; bifurcation; distal; drug-eluting stent(s); everolimus-eluting stent(s); frequency-domain optical coherence tomography; neointimal hyperplasia; ostial-body; percutaneous coronary intervention; sirolimus-eluting stent(s); stent thrombosis; strut-level intimal thickness; unprotected left main coronary artery; unprotected left main coronary artery disease