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

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• 作者：Yusuke Fujino^a ; ^{yusuke.fujino1979@gmail.com} ; Guilherme F. Attizzani^b ; Satoko Tahara^a ; Toru Naganuma^a ; Kensuke Takagi^a ; Hiroto Yabushita^a ; Wei Wang^c ; Kentaro Tanaka^a ; Takahiro Matsumoto^a ; Hiroyoshi Kawamoto^a ; Yuya Yamada^d ; Shinnosuke Amano^d ; Yusuke Watanabe^a ; Takayuki Warisawa^a ; Tomohiko Sato^a ; Satoru Mitomo^a ; Naoyuki Kurita^a ; Hisaaki Ishiguro^a ; Koji Hozawa^a ; Takahiro Tsukahara^d ; Masahiro Motosuke^d ; Hiram G. Bezerra^b ; Shotaro Nakamura^a ; Sunao Nakamura^a
• 关键词：AO ; adjacent to the ostium ; DES ; drug eluting stents ; EES ; everolimus-eluting stents ; EF ; ejection fraction ; KBT ; kissing-balloon technique ; LAD ; left anterior descending artery ; LCx ; left circumflex artery ; NIH ; neointimal hyperplasia ; OCT ; optical coherence tomography ; OO ; opposite to the ostium ; PCI ; percutaneous coronary intervention ; POC ; polygon of confluence ; POT ; proximal optimization technique ; QCA ; quantitative coronary angiography ; ROI ; region of interest ; SB ; side branch ; SES ; siroli
• 刊名：International Journal of Cardiology
• 出版年：2017
• 出版时间：1 March 2017
• 年：2017
• 卷：230
• 期：Complete
• 页码：284-292
• 全文大小：1854 K
• 卷排序：230

文摘

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).MethodsWe prospectively enrolled 38 consecutive patients with ULM disease, who were treated with single-stent 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 everolimus-eluting 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.ResultsPost-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 struts in LCX ostium and ostial area narrowing (r = 0.771, p < 0.001).ConclusionsOCT 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.