title: Delayed coverage of drug-eluting stents after interventional revascularisation of chronic total occlusions assessed by optical coherence tomography: the ALSTER-OCT-CTO registry.
abstract: OBJECTIVE
  Following percutaneous coronary interventions (PCI) for revascularisation of chronic total occlusions (CTO) patients are at increased risk for stent thrombosis (ST). Delayed drug-eluting stent (DES) coverage has previously been shown to be related to ST. Using optical coherence tomography (OCT), we tested the hypothesis that CTO-PCI is associated with delayed DES coverage compared to non-CTO lesions.
  
  
  RESULTS
  From 06/2010 to 11/2013, 105 patients (111 lesions) with clinically driven follow-up angiography after PCI with DES received an OCT analysis. Patients with successful CTO-PCI (19 patients/20 lesions, 6.5±2.1 months post PCI) were included in the CTO group, and patients with non-CTO lesions and total stent length >24 mm (28 patients/28 lesions, 4.9±2.2 months post PCI) were used as a control group. Struts were analysed by OCT (CTO vs. control, mean±SD): covered: 68.9±21.9% vs. 89.6±10.4%, p<0.001; uncovered apposed: 20.2±16.2% vs. 7.5±8.7%, p=0.001; uncovered malapposed: 10.9±10.3% vs. 2.9±2.6%, p<0.001. Neointimal thickness was 92.0±61.2 m vs. 109.3±39.2 m, p=0.033. No differences concerning different CTO-PCI approaches were found.
  
  
  CONCLUSIONS
  A significantly delayed DES coverage after CTO-PCI was observed. Given the known increased rate of ST following CTO-PCI and the known association between delayed DES coverage and ST, OCT may aid in determining the optimal duration of dual antiplatelet therapy after CTO-PCI.
authors.affiliation: Department of Cardiology, Asklepios Clinic St. Georg, Hamburg, Germany.
authors.forename: Christian-Hendrik
authors.initials: CH
authors.lastname: Heeger
authors.forename: Andreas
authors.initials: A
authors.lastname: Busjahn
authors.forename: Laura
authors.initials: L
authors.lastname: Hildebrand
authors.forename: Maximillian
authors.initials: M
authors.lastname: Fenski
authors.forename: Felix
authors.initials: F
authors.lastname: Lesche
authors.forename: Felix
authors.initials: F
authors.lastname: Meincke
authors.forename: Karl-Heinz
authors.initials: KH
authors.lastname: Kuck
authors.forename: Martin Walter
authors.initials: MW
authors.lastname: Bergmann
mesh_terms: D000368:Aged; D002317:Cardiovascular Agents / Q000008:administration & dosage*; D016022:Case-Control Studies; D002908:Chronic Disease; D017023:Coronary Angiography; D054059:Coronary Occlusion / Q000000981:diagnostic imaging / Q000473:pathology / Q000628:therapy*; D003328:Coronary Thrombosis / Q000209:etiology / Q000473:pathology / Q000517:prevention & control; D003331:Coronary Vessels / Q000000981:diagnostic imaging / Q000187:drug effects* / Q000473:pathology; D004359:Drug Therapy, Combination; D054855:Drug-Eluting Stents; D005260:Female; D005858:Germany; D006801:Humans; D008297:Male; D008875:Middle Aged; D058426:Neointima; D062645:Percutaneous Coronary Intervention / Q000009:adverse effects / Q000295:instrumentation*; D010975:Platelet Aggregation Inhibitors / Q000008:administration & dosage; D011237:Predictive Value of Tests; D011474:Prosthesis Design; D012042:Registries; D013997:Time Factors; D041623:Tomography, Optical Coherence; D016896:Treatment Outcome
chemical_list: D002317:Cardiovascular Agents; D010975:Platelet Aggregation Inhibitors