Impacts of lesion angle on incidence and distribution of acute vessel wall injuries and strut malapposition after drug-eluting stent implantation assessed by optical coherence tomography.
OBJECTIVE
To investigate the impact of lesion angle on the incidence and distribution of acute vessel wall injuries and incomplete stent apposition (ISA) following second-generation drug-eluting stent (DES) implantation using optical coherence tomography (OCT). Several ex vivo studies demonstrated that angled arterial walls are exposed to imbalanced mechanical stress from deployed stents.


RESULTS
We included 243 lesions treated with a single DES (148 everolimus-eluting stent and 95 zotarolimus-eluting stent). Angled lesions were defined as lesions with angle ≥45° on an angiogram (n = 58). The vessel wall injuries and ISA were evaluated by OCT. The results were compared with non-angled lesions (<45°, n = 185). The incidence of instent dissection, thrombus, and ISA was significantly higher in the angled group than in the non-angled group (84.5 vs. 63.2%, P < 0.01; 55.2 vs. 35.1%, P < 0.01; 75.9 vs. 44.9%, P < 0.001, respectively). In the angled group, the normalized tissue protrusion volume around the centre of angle (6.59 ± 6.81, mm(3) × 10(2)) was higher than in the distal sub-segment (2.21 ± 2.87, mm3 × 10(2), P < 0.001), in the proximal sub-segment (4.14 ± 5.34, mm3 × 10(2), P = 0.02), and in the non-angled group (3.30 ± 2.81, mm3 × 10(2), P < 0.001). The incidence of major adverse cardiac events within 12 months was similar between the groups.


CONCLUSIONS
Angled coronary lesions had a higher incidence rate of OCT-detected vessel wall injuries and ISA compared with non-angled lesions following second-generation DES implantation. Further studies are needed to understand the long-term clinical significance of these findings.
Cardiology Division, Massachusetts General Hospital, Harvard Medical School, GRB 800, 55 Fruit Street, Boston, MA 02114, USA.
Yoshiyasu
Y
Minami
Cardiology Division, Massachusetts General Hospital, Harvard Medical School, GRB 800, 55 Fruit Street, Boston, MA 02114, USA.
Daniel S
DS
Ong
First Department of Medicine, Nara Medical University, Nara, Japan.
Shiro
S
Uemura
Massachusetts Institute of Technology, Cambridge, MA, USA.
Zhao
Z
Wang
Cardiology Division, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA.
Aaron D
AD
Aguirre
Cardiology Division, Massachusetts General Hospital, Harvard Medical School, GRB 800, 55 Fruit Street, Boston, MA 02114, USA.
Shankha
S
Mukhopadhyay
Cardiology Division, Massachusetts General Hospital, Harvard Medical School, GRB 800, 55 Fruit Street, Boston, MA 02114, USA.
Tsunenari
T
Soeda
Cardiology Division, Massachusetts General Hospital, Harvard Medical School, GRB 800, 55 Fruit Street, Boston, MA 02114, USA.
Rocco
R
Vergallo
Cardiology Division, Massachusetts General Hospital, Harvard Medical School, GRB 800, 55 Fruit Street, Boston, MA 02114, USA Department of Cardiology, The Second Affiliated Hospital of Harbin Medical University, Harbin, China.
Haibo
H
Jia
Cardiology Division, Massachusetts General Hospital, Harvard Medical School, GRB 800, 55 Fruit Street, Boston, MA 02114, USA Department of Cardiology, The Second Affiliated Hospital of Harbin Medical University, Harbin, China.
Jinwei
J
Tian
Cardiology Division, Massachusetts General Hospital, Harvard Medical School, GRB 800, 55 Fruit Street, Boston, MA 02114, USA Department of Cardiology, The Second Affiliated Hospital of Harbin Medical University, Harbin, China.
Sining
S
Hu
Kyung Hee University Hospital, Seoul, Republic of Korea.
Soo Joong
SJ
Kim
Kyung Hee University Hospital at Gangdong, Seoul, Republic of Korea.
Chang-Bum
CB
Park
University of Vermont, Burlington, VT, USA.
Harold L
HL
Dauerman
Queen Mary Hospital, Pok Fu Lam, Hong Kong.
Stephen
S
Lee
Cardiology Division, Massachusetts General Hospital, Harvard Medical School, GRB 800, 55 Fruit Street, Boston, MA 02114, USA Kyung Hee University Hospital, Seoul, Republic of Korea ijang@mgh.harvard.edu.
Ik-Kyung
IK
Jang
D000328:Adult; D017023:Coronary Angiography; D003327:Coronary Disease / Q000188:drug therapy*; D003331:Coronary Vessels / Q000293:injuries*; D054855:Drug-Eluting Stents / Q000009:adverse effects*; D000068338:Everolimus / Q000008:administration & dosage; D005260:Female; D006801:Humans; D015994:Incidence; D008297:Male; D062645:Percutaneous Coronary Intervention; D012042:Registries; D020123:Sirolimus / Q000008:administration & dosage / Q000031:analogs & derivatives; D013314:Stress, Mechanical; D041623:Tomography, Optical Coherence; D057772:Vascular System Injuries / Q000175:diagnosis* / Q000209:etiology*
D000068338:Everolimus; C489443:zotarolimus; D020123:Sirolimus
Drug-eluting stent; Optical coherence tomography; Post-stent complication