Impacts of lesion angle on incidence and distribution of acute vessel wall injuries and strut malapposition after drug-eluting stent implantation assessed by optical coherence tomography

作者：Minami, Yoshiyasu; Ong, Daniel S.; Uemura, Shiro; Wang, Zhao; Aguirre, Aaron D.; Mukhopadhyay, Shankha; Soeda, Tsunenari; Vergallo, Rocco; Jia, Haibo; Tian, Jinwei; Hu, Sining; Kim, Soo Joong; Park, Chang-Bum; Dauerman, Harold L.; Lee, Stephen; Jang, Ik-Kyung^*

来源：European Heart Journal-Cardiovascular Imaging, 2015, 16(12): 1390-1398.

DOI：10.1093/ehjci/jev108

• Optical coherence tomography
• Drug-eluting stent
• Post-stent complication

Aims To investigate the impact of lesion angle on the incidence and distribution of acute vessel wall injuries and incomplete stent apposition (ISA) following second-generation drug-eluting stent (DES) implantation using optical coherence tomography (OCT). Several ex vivo studies demonstrated that angled arterial walls are exposed to imbalanced mechanical stress from deployed stents. @@@ Methods and results We included 243 lesions treated with a single DES (148 everolimus-eluting stent and 95 zotarolimus-eluting stent). Angled lesions were defined as lesions with angle >= 45 degrees onan angiogram(n = 58). The vessel wall injuries and ISA were evaluated by OCT. The results were compared with non-angled lesions (<45 degrees, n = 185). The incidence of instent dissection, thrombus, and ISA was significantly higher in the angled group than in the non-angled group (84.5 vs. 63.2%, P < 0.01; 55.2 vs. 35.1%, P < 0.01; 75.9 vs. 44.9%, P < 0.001, respectively). In the angled group, the normalized tissue protrusion volume around the centreofangle(6.59 +/- 6.81, mm(3) x 10(2)) washigher than in the distal sub-segment (2.21 +/- 2.87, mm(3) x 10(2), P < 0.001), in the proximal sub-segment (4.14 +/- 5.34, mm(3) x 10(2), P = 0.02), and in the non-angled group (3.30 +/- 2.81, mm(3) x 10(2), P < 0.001). The incidence of major adverse cardiac events within 12 months was similar between the groups. @@@ Conclusions Angled coronary lesions had a higher incidence rate of OCT-detected vessel wall injuries and ISA compared with non-angled lesions following second-generation DES implantation. Further studies are needed to understand the long-term clinical significance of these findings.

• 出版日期2015-12
• 单位哈尔滨医科大学