Multi-modality imaging for stent edge assessment.
Optical coherence tomography (OCT) has a sufficiently high resolution to allow assessment of stent edge dissection (ED). The aims of the present study were as follows: (1) evaluation of the frequency of stent ED using OCT; (2) comparison of stent ED detection rates obtained using angiography, intravascular ultrasound (IVUS), and OCT; and (3) IVUS-Virtual Histology (IVUS-VH) evaluation of plaque composition at the site of stent EDs detected by OCT after percutaneous coronary intervention (PCI). Fifty-eight consecutive patients (59 lesions, 100 stent edges) who underwent balloon-expandable stent implantation and post-stent assessment with OCT and IVUS-VH were included. OCT revealed stent ED in 24.0 % (24 of 100) of stent edges after PCI with a balloon-expandable stent. In contrast, ED was detected in only 3.0 % (3 of 100) of stent edges using angiography and 4.0 % (4 of 100) of stent edges using IVUS. Plaque evaluation using IVUS-VH showed that the percent necrotic core (21.2 ± 8.3 vs. 13.4 ± 10.7 %, p = 0.001) and absolute dense calcium (2.9 ± 2.4 vs. 1.3 ± 2.2 mm(3), p = 0.0104) and dense calcium (13.8 ± 9.3 vs. 5.4 ± 5.8 %, p < 0.001) volumes were greater in the ED group than in the non-ED group. Thus, OCT is superior to conventional coronary angiography and IVUS in the identification of stent ED. In addition, the plaque composition at the ED site is characterized by a necrotic core and greater dense calcium levels than those observed at the non-ED site.
Department of Cardiology, Ulsan University Hospital, University of Ulsan College of Medicine, 290-3 Jeonha-dong, Dong-gu, Ulsan, 682-714, South Korea.
Soe Hee
SH
Ann
Kyung Hun
KH
Lim
Cai
C
De Jin
Eun-Seok
ES
Shin
D000368:Aged; D017023:Coronary Angiography; D003324:Coronary Artery Disease / Q000175:diagnosis / Q000628:therapy*; D003331:Coronary Vessels / Q000000981:diagnostic imaging / Q000473:pathology; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D064847:Multimodal Imaging / Q000379:methods*; D009336:Necrosis; D062645:Percutaneous Coronary Intervention / Q000009:adverse effects / Q000295:instrumentation*; D011237:Predictive Value of Tests; D012189:Retrospective Studies; D015607:Stents; D041623:Tomography, Optical Coherence; D016896:Treatment Outcome; D018084:Ultrasonography, Interventional; D061205:Vascular Calcification / Q000175:diagnosis / Q000628:therapy