title: Optical coherence tomography assessment of incidence, morphological characteristics, and spontaneous healing course of edge dissections following percutaneous coronary intervention with stent implantation in patients with non-ST segment elevation myocardial infarction.
abstract: BACKGROUND
  Stenting-induced edge dissections (ED) can be assessed in detail by optical coherence tomography (OCT). This study sought to investigate the incidence, morphological characteristics, and spontaneous healing course of OCT-identified EDs following drug-eluting stent (DES) implantation in a non-ST segment elevation myocardial infarction (NSTEMI) patient-population.
  
  
  METHODS
  Acute vessel wall injury at the 5-mm stent adjacent distal and proximal reference segments was assessed by post-procedure OCT and intravascular ultrasound (IVUS) in n=97 NSTEMI-patients (n=97 lesions). Six months OCT follow-up was available in 82 patients (including 35 untreated post-procedure EDs).
  
  
  RESULTS
  The overall incidence of post-procedure OCT-detected ED was 38 per 97 patients (39.2%), and 47 per 182 stent edges (25.8%). None of the EDs were angiographically visualizable, while 10 (21.3%) were visible on concomitant IVUS-analysis. Morphologically, there was a significant difference in plaque type present at ED-edges vs. non-ED-edges when assessed with OCT; (1) lipid-rich and calcified plaques: 80.9% vs. 57.0%, (2) fibrous plaques: 17.0% vs. 26.7%, and (3) normal coronary vessels: 2.1% vs. 16.3%, p<0.01. Plaqueburden, assessed by IVUS, was substantially larger at ED-containing borders: 54.5±10.0% vs. 43.7±11.6%, p=0.01. Three dissections (8.6%) were incompletely healed at 6-month OCT follow-up. None of the EDs caused cardiac events during the 6-month follow-up, however, 1 ED-patient had target lesion revascularization with PCI and DES-implantation in extension of the scheduled OCT-control.
  
  
  CONCLUSIONS
  OCT-detected EDs were frequent after stent implantation due to NSTEMI, and the majority of these EDs healed without leading to an adverse prognosis at 6months.
authors.affiliation: Department of Cardiology, Odense University Hospital, Odense, Denmark. Electronic address: dr_lissie@hotmail.com.
authors.forename: Lisbeth
authors.initials: L
authors.lastname: Antonsen
authors.affiliation: Department of Cardiology, Odense University Hospital, Odense, Denmark.
authors.forename: Per
authors.initials: P
authors.lastname: Thayssen
authors.affiliation: Department of Cardiology, Odense University Hospital, Odense, Denmark.
authors.forename: Henrik Steen
authors.initials: HS
authors.lastname: Hansen
authors.affiliation: Department of Cardiology, Odense University Hospital, Odense, Denmark.
authors.forename: Anders
authors.initials: A
authors.lastname: Junker
authors.affiliation: Department of Cardiology, Odense University Hospital, Odense, Denmark.
authors.forename: Karsten Tange
authors.initials: KT
authors.lastname: Veien
authors.affiliation: Department of Cardiology, Odense University Hospital, Odense, Denmark.
authors.forename: Knud Nørregaard
authors.initials: KN
authors.lastname: Hansen
authors.affiliation: Department of Cardiology, Odense University Hospital, Odense, Denmark.
authors.forename: Mikkel
authors.initials: M
authors.lastname: Hougaard
authors.affiliation: Department of Cardiology, Odense University Hospital, Odense, Denmark.
authors.forename: Lisette Okkels
authors.initials: LO
authors.lastname: Jensen
mesh_terms: D000368:Aged; D017023:Coronary Angiography; D003324:Coronary Artery Disease / Q000175:diagnosis / Q000453:epidemiology* / Q000209:etiology; D003331:Coronary Vessels / Q000000981:diagnostic imaging* / Q000293:injuries; D003718:Denmark / Q000453:epidemiology; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D015994:Incidence; D008297:Male; D008875:Middle Aged; D000072658:Non-ST Elevated Myocardial Infarction / Q000175:diagnosis / Q000601:surgery*; D062645:Percutaneous Coronary Intervention / Q000009:adverse effects*; D011183:Postoperative Complications; D011379:Prognosis; D011446:Prospective Studies; D012075:Remission, Spontaneous; D015607:Stents / Q000009:adverse effects*; D041623:Tomography, Optical Coherence / Q000379:methods*; D016896:Treatment Outcome; D018084:Ultrasonography, Interventional; D057772:Vascular System Injuries / Q000175:diagnosis* / Q000453:epidemiology / Q000209:etiology
keywords: Drug-eluting stents; Edge dissections; Intravascular ultrasound; Optical coherence tomography; Plaque morphology