Healing course of acute vessel wall injury after drug-eluting stent implantation assessed by optical coherence tomography.
BACKGROUND
Vessel wall injury after drug-eluting stent (DES) implantation can be characterized in detail by optical coherence tomography (OCT). Little is known about the healing course of these phenomena.


RESULTS
In 62 lesions (62 patients), the incidence of acute vessel trauma was assessed in the stented region and the edge segments immediately after DES implantation. The healing course of these injuries was assessed at 9-month OCT follow-up using a software algorithm allowing for reliable spatial comparison of baseline and follow-up cross-sectional images. Tissue prolapse (TP) and tissue protrusions were detected in 81 and 35% of lesions, respectively. A total of 342 intra-stent dissection flaps (ISD) and 114 intra-stent dissection cavities (ISC) were visualized in 98 and 81% of lesions, respectively. Thirty-five lesions (56%) showed edge dissections (EDs). No residual TP or protrusion was observed at follow-up. Incomplete healing was seen in 8% of ISD and in 20% of ISC. For ED, a residual flap was observed in one-third of the initially dissected stent edges. Incomplete healing of acute vessel injury was associated with the presence of underlying atherosclerotic disease at baseline. Uncovered and malapposed stent struts were observed more often with incomplete healing of vessel injury at follow-up.


CONCLUSIONS
Acute vessel wall trauma is highly prevalent immediately after DES implantation. Most of these injuries are minor and resolve at mid-term follow-up. Incomplete healing of ISDs seems to be associated with other OCT findings suggesting delayed arterial healing.
Department of Cardiovascular Diseases, University Hospitals Leuven, Herestraat 49, 3000 Leuven, Leuven, Belgium decockdries@gmail.com.
Dries
D
De Cock
Department of Cardiovascular Diseases, University Hospitals Leuven, Herestraat 49, 3000 Leuven, Leuven, Belgium.
Johan
J
Bennett
Department of Cardiovascular Sciences, Katholieke Universiteit Leuven, Leuven, Belgium.
Giovanni J
GJ
Ughi
Department of Cardiovascular Diseases, University Hospitals Leuven, Herestraat 49, 3000 Leuven, Leuven, Belgium Department of Cardiovascular Sciences, Katholieke Universiteit Leuven, Leuven, Belgium.
Christophe
C
Dubois
Department of Cardiovascular Diseases, University Hospitals Leuven, Herestraat 49, 3000 Leuven, Leuven, Belgium Department of Cardiovascular Sciences, Katholieke Universiteit Leuven, Leuven, Belgium.
Peter
P
Sinnaeve
Department of Cardiovascular Sciences, Katholieke Universiteit Leuven, Leuven, Belgium.
Jan
J
Dhooge
Department of Cardiovascular Diseases, University Hospitals Leuven, Herestraat 49, 3000 Leuven, Leuven, Belgium Department of Cardiovascular Sciences, Katholieke Universiteit Leuven, Leuven, Belgium.
Walter
W
Desmet
Interuniversity Institute for Biostatistics and Statistical Bioinformatics, Katholieke Universiteit Leuven, Leuven, Belgium.
Ann
A
Belmans
Department of Cardiovascular Diseases, University Hospitals Leuven, Herestraat 49, 3000 Leuven, Leuven, Belgium Department of Cardiovascular Sciences, Katholieke Universiteit Leuven, Leuven, Belgium.
Tom
T
Adriaenssens
D000208:Acute Disease; D000368:Aged; D000704:Analysis of Variance; D015906:Angioplasty, Balloon, Coronary / Q000009:adverse effects* / Q000379:methods; D017023:Coronary Angiography / Q000379:methods; D023921:Coronary Stenosis / Q000000981:diagnostic imaging / Q000628:therapy; D003331:Coronary Vessels / Q000293:injuries*; D054855:Drug-Eluting Stents / Q000009:adverse effects*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D013997:Time Factors; D041623:Tomography, Optical Coherence / Q000379:methods*; D057772:Vascular System Injuries / Q000175:diagnosis*; D014945:Wound Healing / Q000502:physiology
drug-eluting stent; edge dissection; intra-stent dissection; optical coherence tomography; tissue prolapse