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

L. Antonsen, P. Thayssen, H. S. Hansen, A. Junker, K. T. Veien, K. N. Hansen, M. Hougaard, L. O. Jensen

Research output: Contribution to journalJournal articleResearchpeer-review

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 6 months.

Original languageEnglish
JournalInternational Journal of Cardiology
Volume223
Pages (from-to)466-474
ISSN0167-5273
DOIs
Publication statusPublished - 15. Nov 2016

Bibliographical note

ISI Document Delivery No.: EB0LV Times Cited: 0 Cited Reference Count: 30 Antonsen, Lisbeth Thayssen, Per Hansen, Henrik Steen Junker, Anders Veien, Karsten Tange Hansen, Knud Norregaard Hougaard, Mikkel Jensen, Lisette Okkels Danish Heart Foundation The Danish Heart Foundation supported this study. 0 3 Elsevier ireland ltd Clare 1874-1754

Keywords

  • Optical coherence tomography Intravascular ultrasound Edge dissections Plaque morphology Drug-eluting stents intravascular ultrasound predictors thrombosis outcomes artery atherosclerosis trials ivus Cardiovascular System & Cardiology
  • Optical coherence tomography
  • Edge dissections
  • Drug-eluting stents
  • Intravascular ultrasound
  • Plaque morphology
  • Prognosis
  • Prospective Studies
  • Follow-Up Studies
  • Humans
  • Middle Aged
  • Ultrasonography, Interventional
  • Male
  • Non-ST Elevated Myocardial Infarction/diagnosis
  • Incidence
  • Female
  • Postoperative Complications
  • Percutaneous Coronary Intervention/adverse effects
  • Treatment Outcome
  • Coronary Angiography
  • Coronary Artery Disease/diagnosis
  • Denmark/epidemiology
  • Tomography, Optical Coherence/methods
  • Remission, Spontaneous
  • Stents/adverse effects
  • Vascular System Injuries/diagnosis
  • Aged
  • Coronary Vessels/diagnostic imaging

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