Optical coherence tomography analysis of the stent strut and prediction of resolved strut malapposition at 3 months after 2nd-generation drug-eluting stent implantation.
Our objective was to clarify whether thrombogenic problems with stent struts are resolved at 3 months after 2nd-generation drug-eluting stent implantation. Twenty-one patients with stable angina pectoris having 28 (22 zotarolimus-eluting, 6 everolimus-eluting) stents with optical coherence tomography (OCT)-guided percutaneous coronary intervention (PCI) were evaluated. Stent strut coverage and malapposition were evaluated by OCT immediately after PCI and at 3-month follow-up. Acute strut malapposition was observed in 26 out of 28 analyzed stents (92.9 %). At 3-month follow-up, 7 (26.9 %) of those 26 stents with strut malapposition were completely resolved, and the mean percentages of uncovered struts and malapposed struts were 8.3 and 2.0 % when analyzed by each individual stent. When analyzing a total of 30,060 struts, 807 struts (2.7 %) demonstrated acute strut malapposition. Among these, 219 struts (27.1 %) demonstrated persistent strut malapposition. On the basis of receiver-operating characteristic curve analysis, a strut-to-vessel (S-V) distance ≤160 µm on post-stenting OCT images was the corresponding cutoff point for resolved malapposed struts (sensitivity 78.1 %, specificity 62.8 %, area under the curve 0.758). The S-V distance of persistent malapposed struts on post-stenting OCT images was longer than that of resolved malapposed struts (235 ± 112 vs. 176 ± 93 µm, p < 0.01). At 3 months after PCI, the prevalence rates of uncovered and malapposed struts were relatively low in 2nd-generation drug-eluting stent. Our results suggest that OCT-guide PCI with an S-V distance ≤160 µm may be recommended especially in patients with planed short-term DAPT.
Department of Cardiology, Japanese Red Cross Ise Hospital, 1-471-2 Funae, Ise-City, Mie, 516-8512, Japan. daisukeizumi@hotmail.com.
Daisuke
D
Izumi
Department of Cardiology, Matsusaka Central General Hospital, Matsusaka, Mie, Japan.
Masatoshi
M
Miyahara
Department of Molecular and Laboratory Medicine, Mie University Graduate School of Medicine, Tsu, Mie, Japan.
Naoki
N
Fujimoto
Department of Cardiology, Matsusaka Central General Hospital, Matsusaka, Mie, Japan.
Shusuke
S
Fukuoka
Department of Cardiology, Matsusaka Central General Hospital, Matsusaka, Mie, Japan.
Masataka
M
Sakai
Department of Cardiology and Nephrology, Mie University Graduate School of Medicine, Tsu, Mie, Japan.
Kaoru
K
Dohi
Department of Cardiology and Nephrology, Mie University Graduate School of Medicine, Tsu, Mie, Japan.
Masaaki
M
Ito
D000368:Aged; D001241:Aspirin / Q000008:administration & dosage; D000077144:Clopidogrel; D003324:Coronary Artery Disease / Q000628:therapy*; D003331:Coronary Vessels / Q000000981:diagnostic imaging*; D054855:Drug-Eluting Stents / Q000009:adverse effects*; D000068338:Everolimus / Q000494:pharmacology; D005260:Female; D006801:Humans; D007564:Japan; D008297:Male; D008875:Middle Aged; D062645:Percutaneous Coronary Intervention; D010975:Platelet Aggregation Inhibitors / Q000008:administration & dosage; D011474:Prosthesis Design; D020123:Sirolimus / Q000031:analogs & derivatives / Q000494:pharmacology; D013927:Thrombosis / Q000000981:diagnostic imaging / Q000209:etiology; D013988:Ticlopidine / Q000008:administration & dosage / Q000031:analogs & derivatives; D041623:Tomography, Optical Coherence
D010975:Platelet Aggregation Inhibitors; D000068338:Everolimus; D000077144:Clopidogrel; C489443:zotarolimus; D013988:Ticlopidine; D001241:Aspirin; D020123:Sirolimus
Drug-eluting stents; Optical coherence tomography; Strut malapposition