title: Impact of strut-vessel distance and underlying plaque type on the resolution of acute strut malapposition: serial optimal coherence tomography analysis after everolimus-eluting stent implantation.
abstract: The consequences of acute strut malapposition in everolimus-eluting stents (EES) are unknown. This study investigated the impact of strut-vessel (S-V) distance and plaque type underneath acute strut malapposition on the mid-term vessel response in EES. Twenty-nine patients (35 EES) underwent optical coherence tomography (OCT) immediately after percutaneous coronary intervention and at 8-month follow-up. S-V distance and plaque type (lipid, calcified, or fibrous) underneath acute strut malapposition were evaluated. Follow-up OCT classified acute strut malapposition as persistent or resolved. The S-V cutoff value for predicting resolved strut malapposition and the incidence of intra-stent thrombi were determined. Among 569 cases of acute strut malapposition, involving 29,168 struts, 139 (24.4 %) were persistent. Mean S-V distance was significantly longer in persistent than in resolved strut malapposition (600 ± 294 vs. 231 ± 95 μm; P < 0.0001). S-V distance ≤380 μm was the best cutoff value for predicting resolved strut malapposition (sensitivity 93.5 %, specificity 69.8 %, area under curve 0.878). Acute strut malapposition with S-V distance ≤380 μm remained persistent more frequently over lipid/calcified than over fibrous plaques (lipid: 13.4 %, calcified: 18.2 %, fibrous: 4.2 %; lipid vs. fibrous, P = 0.001; calcified vs. fibrous, P = 0.02). Intra-stent thrombi were more frequent in stents with ≥1 persistent strut malapposition than in those without [4/11 stents (36.3 %) vs. 0/24 (0 %); P = 0.006]. Lipid and calcified plaque, together with S-V distance, affect the resolution of acute strut malapposition in EES. Persistent strut malapposition is associated with the presence of thrombi at follow-up, which could be the substrate for late stent thrombosis.
authors.affiliation: Division of Cardiovascular Medicine, Department of Internal Medicine, Kobe University Graduate School of Medicine, 7-5-1 Kusunoki-cho, Chuo-ku, Kobe, Hyogo, 650-0017, Japan.
authors.forename: Takumi
authors.initials: T
authors.lastname: Inoue
authors.forename: Toshiro
authors.initials: T
authors.lastname: Shinke
authors.forename: Hiromasa
authors.initials: H
authors.lastname: Otake
authors.forename: Masayuki
authors.initials: M
authors.lastname: Nakagawa
authors.forename: Hirotoshi
authors.initials: H
authors.lastname: Hariki
authors.forename: Tsuyoshi
authors.initials: T
authors.lastname: Osue
authors.forename: Masamichi
authors.initials: M
authors.lastname: Iwasaki
authors.forename: Yu
authors.initials: Y
authors.lastname: Taniguchi
authors.forename: Ryo
authors.initials: R
authors.lastname: Nishio
authors.forename: Noritoshi
authors.initials: N
authors.lastname: Hiranuma
authors.forename: Akihide
authors.initials: A
authors.lastname: Konishi
authors.forename: Hiroto
authors.initials: H
authors.lastname: Kinutani
authors.forename: Masaru
authors.initials: M
authors.lastname: Kuroda
authors.forename: Ken-ichi
authors.initials: K
authors.lastname: Hirata
mesh_terms: D000368:Aged; D003327:Coronary Disease / Q000188:drug therapy* / Q000601:surgery; D054855:Drug-Eluting Stents / Q000009:adverse effects*; D000068338:Everolimus; D005260:Female; D006801:Humans; D007166:Immunosuppressive Agents / Q000008:administration & dosage*; D008297:Male; D062645:Percutaneous Coronary Intervention; D058226:Plaque, Atherosclerotic / Q000188:drug therapy* / Q000473:pathology; D011183:Postoperative Complications / Q000175:diagnosis*; D011475:Prosthesis Failure / Q000009:adverse effects*; D012680:Sensitivity and Specificity; D020123:Sirolimus / Q000008:administration & dosage / Q000031:analogs & derivatives*; D041623:Tomography, Optical Coherence
chemical_list: D007166:Immunosuppressive Agents; D000068338:Everolimus; D020123:Sirolimus
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