title: Time course of vascular response after an a priori strategy of bare metal stent implantation post-dilated with a paclitaxel-coated balloon: Implementation of a three-dimensional analysis algorithm with optical coherence tomography.
abstract: BACKGROUND
  An a priori combined therapy of a bare metal stent post-dilated with a paclitaxel- -coated balloon (PCB) was investigated with optical coherence tomography (OCT) at 2 and 6 months regarding vessel response. Previous studies have shown inconsistent results and the time course of vessel healing after such an interventional strategy is unknown.
  
  
  METHODS
  Thirty-three de novo lesions in 32 patients were electively treated. Six-month OCT analysis was available in 24 lesions. Two-month OCT follow-up was obtained in 16 lesions. Sequential OCT at 2 and 6 months was available in 7 patients. A novel 3-dimensional picture of vessel segments as spread outs was implemented.
  
  
  RESULTS
  Severe incomplete stent apposition (ISA) accompanied by significantly lower strut coverage were found at 2-month compared with 6-month follow-up (ISA struts: 11.4 ± 11.8% vs. 1.8 ± 4.8%, p = 0.001; uncovered struts: 14.5 ± 14.8% vs. 2.0 ± 5.3%, p = 0.001). ISA size diminished over time and the possibly observed phenomenon of positive vessel remodeling (remodeling volume: 4.9 ± 5.9 mm3 at 2-months vs. 2.0 ± 2.6 mm3 at 6-months; p = 0.042) was largely reversible in most lesions.
  
  
  CONCLUSIONS
  Bare metal stenting with adjunctive application of paclitaxel by a coated bal-loon shows transient severe incomplete strut apposition, most likely due to focal positive ves-sel remodeling. Thus, caution is needed in bailout situations following a PCB angioplasty. A novel illustration of OCT parameters as "carpet views" enables a comprehensive analysis of investigated stents.
authors.affiliation: 1st Clinic of Medicine, Division of Cardiology, University Hospital of Jena, Germany. sylvia.otto@med.uni-jena.de.
authors.forename: Sylvia
authors.initials: S
authors.lastname: Otto
authors.forename: Johannes
authors.initials: J
authors.lastname: Gassdorf
authors.forename: Kristina
authors.initials: K
authors.lastname: Nitsche
authors.forename: Juan Luis
authors.initials: JL
authors.lastname: Gutiérrez-Chico
authors.forename: Aleh
authors.initials: A
authors.lastname: Kryvanos
authors.forename: Björn
authors.initials: B
authors.lastname: Goebel
authors.forename: Hans R
authors.initials: HR
authors.lastname: Figulla
authors.forename: Tudor C
authors.initials: TC
authors.lastname: Poerner
mesh_terms: D000368:Aged; D000972:Antineoplastic Agents, Phytogenic / Q000494:pharmacology; D017023:Coronary Angiography; D003324:Coronary Artery Disease / Q000175:diagnosis / Q000601:surgery*; D003331:Coronary Vessels / Q000000981:diagnostic imaging* / Q000601:surgery; D054855:Drug-Eluting Stents; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D021621:Imaging, Three-Dimensional; D008297:Male; D017239:Paclitaxel / Q000494:pharmacology*; D011446:Prospective Studies; D011474:Prosthesis Design; D015203:Reproducibility of Results; D013997:Time Factors; D041623:Tomography, Optical Coherence / Q000379:methods*; D014664:Vasodilation / Q000502:physiology*
chemical_list: D000972:Antineoplastic Agents, Phytogenic; D017239:Paclitaxel
keywords: coronary artery disease; drug-coated balloon; optical coherence tomography; percutaneous coronary intervention