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

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• 作者：Lisbeth Antonsen ; ¹ ; ^{dr_lissie@hotmail.com" class="auth_mail" title="E-mail the corresponding author} ; Per Thayssen¹ ; Henrik Steen Hansen¹ ; Anders Junker¹ ; Karsten Tange Veien¹ ; Knud Nø ; rregaard Hansen¹ ; Mikkel Hougaard¹ ; Lisette Okkels Jensen¹
• 关键词：Optical coherence tomography ; Intravascular ultrasound ; Edge dissections ; Plaque morphology ; Drug-eluting stents
• 刊名：International Journal of Cardiology
• 出版年：2016
• 出版时间：15 November 2016
• 年：2016
• 卷：223
• 期：Complete
• 页码：466-474
• 全文大小：1422 K

文摘

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 6 months.