Difference in vascular response between sirolimus-eluting- and everolimus-eluting stents in ostial left circumflex artery after unprotected left main as observed by optical coherence tomography

作者：Fujino Yusuke^*; Attizzani Guilherme F; Tahara Satoko; Naganuma Toru; Takagi Kensuke; Yabushita Hiroto; Wang Wei; Tanaka Kentaro; Matsumoto Takahiro; Kawamoto Hiroyoshi; Yamada Yuya; Amano Shinnosuke; Watanabe Yusuke; Warisawa Takayuki; Sato Tomohiko; Mitomo Satoru; Kurita Naoyuki; Ishiguro Hisaaki; Hozawa Koji; Tsukahara Takahiro; Motosuke Masahiro; Bezerra Hiram G; Nakamura Shotaro; Nakamura Sunao

来源：International Journal of Cardiology, 2017, 230: 284-292.

DOI：10.1016/j.ijcard.2016.12.122

• Left main coronary artery disease
• Percutaneous coronary intervention
• Kissing balloon technique
• Optical coherence tomography

Background: Kissing-balloon technique (KBT) is commonly performed during percutaneous coronary intervention of distal unprotected left main coronary artery (ULM) aiming at obtaining optimal opening of the side branch (left circumflex artery; LCX) ostium. Nonetheless, detailed evaluation of vascular response to stents in LCX ostium is lacking. We therefore evaluated the vascular response to different drug-eluting stents (DES) in ostial LCX after ULM by means of optical coherence tomography (OCT).
Methods: We prospectively enrolled 38 consecutive patients with ULM disease, who were treated with singlestent procedure using DES, crossover the ULM-left anterior descending artery (LAD) followed by KBT. Twelve patients were treated with sirolimus-eluting stents (SES) and 26 patients were treated with everolimuseluting stents (EES). OCT was conducted at post-PCI and 9-month follow-up. We evaluated the DES-vessel interactions and number of stent struts at the side branch (LCX) ostium(SO) at post-PCI, and compared the narrowing of ostial area at LCX between SES and EES.
Results: Post-procedure, the number of stent struts at SO was significantly higher in SES compared to EES (median 14.47% vs 0.19%, p < 0.001). The narrowing of LCX ostial area at follow-up was more pronounced in SES compared with EES (29.16% vs 2.46%, respectively, p < 0.001). Linear regression analysis showed a high correlation between the number of stent truts in LCX ostium and ostial area narrowing (r =0.771, p < 0.001).
Conclusions: OCT showed differences between EES- and SES-vessel interactions at ULM bifurcation PCI. Number of LCX ostium struts at post-PCI impacted the narrowing of ostial area at 9-month follow-up.

• 出版日期2017-3-1