title: The clinical characteristics and prognosis of lesions with in-stent eccentric tissue proliferation and strong signal attenuation detected by optical coherence tomography.
abstract: There are still some patients who require repeat revascularization despite of drug-eluting stent (DES) implantation. The present study aimed to investigate the relationship between optical coherence tomography (OCT) findings and recurring target lesion revascularization (TLR) after percutaneous coronary intervention (PCI) for in-stent restenosis (ISR). We reviewed 50 patients (54 coronary lesions) who underwent PCI for ISR, which included 25 DES-ISR lesions. The PCI strategy depended on the interventionalist's discretion, and DES implantation was performed for 38 (70 %) lesions. Tissue characteristics were assessed qualitatively and quantitatively using the frame showing maximal lumen narrowing (minimal lumen area). In qualitative analysis, OCT detected coexistence of eccentric tissue proliferation and strong signal attenuation (ESA). ESA was observed in six lesions (11 %) in five patients (10 %). Hemodialysis (80 vs. 20 %, p = 0.013) and DES-ISR (100 vs. 40 %, p = 0.0069) were significantly more frequent in ESA patients/lesions than in others. One-year follow-up revealed that re-TLR was more frequently performed for ESA lesions (83 vs. 8 %, p = 0.0002). The findings reveal that ESA detected in OCT images of ISR is related to TLR after PCI for DES-ISR especially in patients undergoing maintenance hemodialysis.
authors.affiliation: Department of Medicine, Teikyo University School of Medicine, 2-11-1 Kaga, Itabashi-ku, Tokyo, Japan. nsuzu@bronze.ocn.ne.jp.
authors.forename: Nobuaki
authors.initials: N
authors.lastname: Suzuki
authors.affiliation: Department of Medicine, Teikyo University School of Medicine, 2-11-1 Kaga, Itabashi-ku, Tokyo, Japan.
authors.forename: Ken
authors.initials: K
authors.lastname: Kozuma
authors.affiliation: Department of Medicine, Teikyo University School of Medicine, 2-11-1 Kaga, Itabashi-ku, Tokyo, Japan.
authors.forename: Hiroyuki
authors.initials: H
authors.lastname: Kyono
authors.affiliation: Department of Medicine, Teikyo University School of Medicine, 2-11-1 Kaga, Itabashi-ku, Tokyo, Japan.
authors.forename: Hiroaki
authors.initials: H
authors.lastname: Nakaya
authors.affiliation: Department of Medicine, Teikyo University School of Medicine, 2-11-1 Kaga, Itabashi-ku, Tokyo, Japan.
authors.forename: Seiji
authors.initials: S
authors.lastname: Nishide
authors.affiliation: Department of Medicine, Teikyo University School of Medicine, 2-11-1 Kaga, Itabashi-ku, Tokyo, Japan.
authors.forename: Miho
authors.initials: M
authors.lastname: Mitsui
authors.affiliation: Department of Medicine, Teikyo University School of Medicine, 2-11-1 Kaga, Itabashi-ku, Tokyo, Japan.
authors.forename: Yugo
authors.initials: Y
authors.lastname: Nara
authors.affiliation: Department of Medicine, Teikyo University School of Medicine, 2-11-1 Kaga, Itabashi-ku, Tokyo, Japan.
authors.forename: Hideyuki
authors.initials: H
authors.lastname: Kawashima
authors.affiliation: Department of Medicine, Teikyo University School of Medicine, 2-11-1 Kaga, Itabashi-ku, Tokyo, Japan.
authors.forename: Takahiro
authors.initials: T
authors.lastname: Nomura
authors.affiliation: Department of Medicine, Teikyo University School of Medicine, 2-11-1 Kaga, Itabashi-ku, Tokyo, Japan.
authors.forename: Hirosada
authors.initials: H
authors.lastname: Yamamoto
authors.affiliation: Department of Pathology, Teikyo University School of Medicine, Tokyo, Japan.
authors.forename: Yuko
authors.initials: Y
authors.lastname: Sasajima
authors.affiliation: Department of Pathology, Teikyo University School of Medicine, Tokyo, Japan.
authors.forename: Fukuo
authors.initials: F
authors.lastname: Kondo
authors.affiliation: Department of Medicine, Teikyo University School of Medicine, 2-11-1 Kaga, Itabashi-ku, Tokyo, Japan.
authors.forename: Takaaki
authors.initials: T
authors.lastname: Isshiki
mesh_terms: D000368:Aged; D017023:Coronary Angiography; D003324:Coronary Artery Disease / Q000175:diagnosis / Q000601:surgery*; D003331:Coronary Vessels / Q000000981:diagnostic imaging* / Q000601:surgery; D054855:Drug-Eluting Stents / Q000009:adverse effects*; D005260:Female; D005500:Follow-Up Studies; D006083:Graft Occlusion, Vascular / Q000175:diagnosis*; D006801:Humans; D008297:Male; D008875:Middle Aged; D062645:Percutaneous Coronary Intervention / Q000009:adverse effects*; D011379:Prognosis; D012189:Retrospective Studies; D012307:Risk Factors; D041623:Tomography, Optical Coherence / Q000379:methods*
keywords: Coronary artery; Drug-eluting stent; Hemodialysis; Optical coherence tomography; Restenosis