title: Optical coherence tomography findings after chronic total occlusion interventions: Insights from the "AngiographiC evaluation of the everolimus-eluting stent in chronic Total occlusions" (ACE-CTO) study (NCT01012869).
abstract: BACKGROUND
  There is limited information on optical coherence tomography (OCT) findings after percutaneous coronary intervention (PCI) of chronic total occlusions (CTOs). OCT allows high resolution imaging that can enhance understanding of the vascular response after stenting of chronically occluded vessels.
  
  
  METHODS
  The Angiographic Evaluation of the Everolimus-Eluting Stent in Chronic Total Occlusions (ACE-CTO) study collected angiographic and clinical outcomes from 100 patients undergoing CTO PCI with the everolimus-eluting stent (EES). OCT was performed 8-months post stenting in 62 patients. Every third frame was analyzed throughout the course of the stented arterial segment. Lumen contours were semi-automatically traced and stent struts were manually delineated, with automatic measurement of the strut to lumen distance. Struts on the luminal side of the lumen contour were classified as malapposed if the distance to the lumen contour exceeded 0.108mm.
  
  
  RESULTS
  A total of 44,450 struts in 6047 frames were analyzed, of which 4113 9.3%, 95% confidence intervals [CI] 9.0% to 9.5%) were malapposed and 1230 (2.8%, 95% CI 2.6% to 2.9%) were uncovered. Fifty-five of 62 patients (88.7%, 95% CI 78.5% to 98.4%) had at least one malapposed stent strut and 50 patients (80.7%, 95% CI 69.2% to 88.6%) had at least one uncovered stent strut. Mean strut-intimal thickness of the apposed and malapposed struts was 0.126±0.140mm and -0.491±0.440mm, respectively.
  
  
  CONCLUSIONS
  High rates of stent strut malapposition and incomplete stent strut coverage were observed after CTO PCI using EES, highlighting unique challenges associated with stent implantation in CTOs.
authors.affiliation: VA North Texas Healthcare System and University of Texas Southwestern Medical Center, Dallas, TX, USA.
authors.forename: Daniel P
authors.initials: DP
authors.lastname: Sherbet
authors.affiliation: VA North Texas Healthcare System and University of Texas Southwestern Medical Center, Dallas, TX, USA.
authors.forename: Georgios
authors.initials: G
authors.lastname: Christopoulos
authors.affiliation: VA North Texas Healthcare System and University of Texas Southwestern Medical Center, Dallas, TX, USA.
authors.forename: Aris
authors.initials: A
authors.lastname: Karatasakis
authors.affiliation: VA North Texas Healthcare System and University of Texas Southwestern Medical Center, Dallas, TX, USA.
authors.forename: Barbara Anna
authors.initials: BA
authors.lastname: Danek
authors.affiliation: VA North Texas Healthcare System and University of Texas Southwestern Medical Center, Dallas, TX, USA.
authors.forename: Anna
authors.initials: A
authors.lastname: Kotsia
authors.affiliation: VA North Texas Healthcare System and University of Texas Southwestern Medical Center, Dallas, TX, USA.
authors.forename: Rachita
authors.initials: R
authors.lastname: Navara
authors.affiliation: VA North Texas Healthcare System and University of Texas Southwestern Medical Center, Dallas, TX, USA.
authors.forename: Tesfaldet T
authors.initials: TT
authors.lastname: Michael
authors.affiliation: VA North Texas Healthcare System and University of Texas Southwestern Medical Center, Dallas, TX, USA.
authors.forename: Michele
authors.initials: M
authors.lastname: Roesle
authors.affiliation: VA North Texas Healthcare System and University of Texas Southwestern Medical Center, Dallas, TX, USA.
authors.forename: Bavana V
authors.initials: BV
authors.lastname: Rangan
authors.affiliation: VA North Texas Healthcare System and University of Texas Southwestern Medical Center, Dallas, TX, USA.
authors.forename: Donald
authors.initials: D
authors.lastname: Haagen
authors.affiliation: Minneapolis VA Healthcare System and University of Minnesota, Minneapolis, MN, USA.
authors.forename: Santiago
authors.initials: S
authors.lastname: Garcia
authors.affiliation: Bon Secours Health System, Suffolk, VA, USA.
authors.forename: Calin
authors.initials: C
authors.lastname: Maniu
authors.affiliation: Banner Good Samaritan Medical Center, Phoenix, AZ, USA.
authors.forename: Ashish
authors.initials: A
authors.lastname: Pershad
authors.affiliation: VA North Texas Healthcare System and University of Texas Southwestern Medical Center, Dallas, TX, USA.
authors.forename: Shuaib M
authors.initials: SM
authors.lastname: Abdullah
authors.affiliation: VA North Texas Healthcare System and University of Texas Southwestern Medical Center, Dallas, TX, USA.
authors.forename: Jeffrey L
authors.initials: JL
authors.lastname: Hastings
authors.affiliation: VA North Texas Healthcare System and University of Texas Southwestern Medical Center, Dallas, TX, USA.
authors.forename: Dharam J
authors.initials: DJ
authors.lastname: Kumbhani
authors.affiliation: VA North Texas Healthcare System and University of Texas Southwestern Medical Center, Dallas, TX, USA.
authors.forename: Michael
authors.initials: M
authors.lastname: Luna
authors.affiliation: VA North Texas Healthcare System and University of Texas Southwestern Medical Center, Dallas, TX, USA.
authors.forename: Tayo
authors.initials: T
authors.lastname: Addo
authors.affiliation: VA North Texas Healthcare System and University of Texas Southwestern Medical Center, Dallas, TX, USA.
authors.forename: Subhash
authors.initials: S
authors.lastname: Banerjee
authors.affiliation: VA North Texas Healthcare System and University of Texas Southwestern Medical Center, Dallas, TX, USA. Electronic address: esbrilakis@gmail.com.
authors.forename: Emmanouil S
authors.initials: ES
authors.lastname: Brilakis
mesh_terms: D000368:Aged; D002317:Cardiovascular Agents / Q000008:administration & dosage*; D002908:Chronic Disease; D017023:Coronary Angiography; D054059:Coronary Occlusion / Q000000981:diagnostic imaging* / Q000628:therapy*; D023903:Coronary Restenosis / Q000000981:diagnostic imaging / Q000209:etiology; D003331:Coronary Vessels / Q000000981:diagnostic imaging*; D054855:Drug-Eluting Stents; D000068338:Everolimus / Q000008:administration & dosage*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D062645:Percutaneous Coronary Intervention / Q000009:adverse effects / Q000295:instrumentation*; D011237:Predictive Value of Tests; D011474:Prosthesis Design; D013997:Time Factors; D041623:Tomography, Optical Coherence; D016896:Treatment Outcome; D014945:Wound Healing
chemical_list: D002317:Cardiovascular Agents; D000068338:Everolimus
keywords: Chronic total occlusion; Everolimus-eluting stent; Optical coherence tomography; Percutaneous coronary intervention