title: Optical coherence tomography assessment of in-stent restenosis after percutaneous coronary intervention with two-stent technique in unprotected left main.
abstract: BACKGROUND
  Optical coherence tomography (OCT) has contributed to a better understanding of in-stent restenosis (ISR); however, studies evaluating ISR pattern after two-stent technique in unprotected left main (ULM) are lacking. We aim to evaluate the ISR pattern of proximal LAD and LCX after two-stent technique in ULM.
  
  
  METHODS
  We performed OCT in 26 patients with isolated or combined ISR (identified by angiography as >50%) after two stent implantation in the proximal LCX and LAD. Finally, 13 LAD and 22 LCX ISR lesions underwent OCT assessments. OCT analyses were undertaken in the proximal segments of the LAD and LCX. In addition, we compared OCT findings in the flow divider (FD) and lateral wall (LW).
  
  
  RESULTS
  In both the LAD and LCX, the distance from the ostium to the minimum lumen area (MLA; LAD, 2.00mm [1.00, 3.00]; LCX, 1.00mm [0.00, 1.80] distal to ostium) was short. Uncovered struts were more common on the FD side compared with the LW in the LAD (6.25% [0.00, 20.00] vs 0.00% [0.00, 0.00], respectively, p=0.016) and LCX (11.32% [0.00, 19.44] vs 0.00% [0.00, 4.55], respectively, p<0.001). Conversely, neointimal hyperplasia (NIH) was significantly thicker on the FD side compared with the LW in the LCX (0.31mm [0.19, 0.47] vs 0.15mm [0.09, 0.31], p<0.001).
  
  
  CONCLUSIONS
  While uncovered struts were more commonly found on the FD side of both arteries, NIH was significantly thicker on the FD side compared with the LW in the LCX. These unique findings might indicate inferior outcomes after two-stent techniques in ULM bifurcation lesions.
authors.affiliation: Department of Cardiology, New Tokyo Hospital, Chiba, Japan. Electronic address: yusuke.fujino1979@gmail.com.
authors.forename: Yusuke
authors.initials: Y
authors.lastname: Fujino
authors.affiliation: Harrington Heart and Vascular Institute, University Hospitals Case Medical Center, Case Western Reserve University, Cleveland, OH, United States.
authors.forename: Guilherme F
authors.initials: GF
authors.lastname: Attizzani
authors.affiliation: Department of Cardiology, New Tokyo Hospital, Chiba, Japan.
authors.forename: Satoko
authors.initials: S
authors.lastname: Tahara
authors.affiliation: Department of Cardiology, New Tokyo Hospital, Chiba, Japan.
authors.forename: Toru
authors.initials: T
authors.lastname: Naganuma
authors.affiliation: Department of Cardiology, New Tokyo Hospital, Chiba, Japan.
authors.forename: Kensuke
authors.initials: K
authors.lastname: Takagi
authors.affiliation: Department of Cardiology, New Tokyo Hospital, Chiba, Japan.
authors.forename: Hiroto
authors.initials: H
authors.lastname: Yabushita
authors.affiliation: Center of Biostatistics and Bioinformatics, University of Mississippi Medical Center, Jackson, MS, United States.
authors.forename: Wei
authors.initials: W
authors.lastname: Wang
authors.affiliation: Department of Cardiology, New Tokyo Hospital, Chiba, Japan.
authors.forename: Takayuki
authors.initials: T
authors.lastname: Warisawa
authors.affiliation: Department of Cardiology, New Tokyo Hospital, Chiba, Japan.
authors.forename: Yusuke
authors.initials: Y
authors.lastname: Watanabe
authors.affiliation: Department of Cardiology, New Tokyo Hospital, Chiba, Japan.
authors.forename: Satoru
authors.initials: S
authors.lastname: Mitomo
authors.affiliation: Department of Cardiology, New Tokyo Hospital, Chiba, Japan.
authors.forename: Tomohiko
authors.initials: T
authors.lastname: Sato
authors.affiliation: Department of Cardiology, New Tokyo Hospital, Chiba, Japan.
authors.forename: Naoyuki
authors.initials: N
authors.lastname: Kurita
authors.affiliation: Department of Cardiology, New Tokyo Hospital, Chiba, Japan.
authors.forename: Hisaaki
authors.initials: H
authors.lastname: Ishiguro
authors.affiliation: Department of Cardiology, New Tokyo Hospital, Chiba, Japan.
authors.forename: Koji
authors.initials: K
authors.lastname: Hozawa
authors.affiliation: Department of Cardiology, New Tokyo Hospital, Chiba, Japan.
authors.forename: Shotaro
authors.initials: S
authors.lastname: Nakamura
authors.affiliation: Harrington Heart and Vascular Institute, University Hospitals Case Medical Center, Case Western Reserve University, Cleveland, OH, United States.
authors.forename: Hiram G
authors.initials: HG
authors.lastname: Bezerra
authors.affiliation: Department of Cardiology, New Tokyo Hospital, Chiba, Japan.
authors.forename: Sunao
authors.initials: S
authors.lastname: Nakamura
mesh_terms: D000368:Aged; D023903:Coronary Restenosis / Q000000981:diagnostic imaging* / Q000209:etiology*; D003331:Coronary Vessels / Q000000981:diagnostic imaging*; D054855:Drug-Eluting Stents / Q000009:adverse effects*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D062645:Percutaneous Coronary Intervention / Q000009:adverse effects* / Q000639:trends; D012189:Retrospective Studies; D041623:Tomography, Optical Coherence / Q000379:methods*
keywords: Frequency-domain optical coherence tomography; Percutaneous coronary intervention; Two-stent technique