Dries De Cock1, Johan Bennett2, Giovanni J Ughi3, Christophe Dubois4, Peter Sinnaeve4, Jan Dhooge3, Walter Desmet4, Ann Belmans5, Tom Adriaenssens4. 1. Department of Cardiovascular Diseases, University Hospitals Leuven, Herestraat 49, 3000 Leuven, Leuven, Belgium decockdries@gmail.com. 2. Department of Cardiovascular Diseases, University Hospitals Leuven, Herestraat 49, 3000 Leuven, Leuven, Belgium. 3. Department of Cardiovascular Sciences, Katholieke Universiteit Leuven, Leuven, Belgium. 4. Department of Cardiovascular Diseases, University Hospitals Leuven, Herestraat 49, 3000 Leuven, Leuven, Belgium Department of Cardiovascular Sciences, Katholieke Universiteit Leuven, Leuven, Belgium. 5. Interuniversity Institute for Biostatistics and Statistical Bioinformatics, Katholieke Universiteit Leuven, Leuven, Belgium.
Abstract
BACKGROUND:Vessel wall injury after drug-eluting stent (DES) implantation can be characterized in detail by optical coherence tomography (OCT). Little is known about the healing course of these phenomena. METHODS AND RESULTS: In 62 lesions (62 patients), the incidence of acute vessel trauma was assessed in the stented region and the edge segments immediately after DES implantation. The healing course of these injuries was assessed at 9-month OCT follow-up using a software algorithm allowing for reliable spatial comparison of baseline and follow-up cross-sectional images. Tissue prolapse (TP) and tissue protrusions were detected in 81 and 35% of lesions, respectively. A total of 342 intra-stent dissection flaps (ISD) and 114 intra-stent dissection cavities (ISC) were visualized in 98 and 81% of lesions, respectively. Thirty-five lesions (56%) showed edge dissections (EDs). No residual TP or protrusion was observed at follow-up. Incomplete healing was seen in 8% of ISD and in 20% of ISC. For ED, a residual flap was observed in one-third of the initially dissected stent edges. Incomplete healing of acute vessel injury was associated with the presence of underlying atherosclerotic disease at baseline. Uncovered and malapposed stent struts were observed more often with incomplete healing of vessel injury at follow-up. CONCLUSIONS:Acute vessel wall trauma is highly prevalent immediately after DES implantation. Most of these injuries are minor and resolve at mid-term follow-up. Incomplete healing of ISDs seems to be associated with other OCT findings suggesting delayed arterial healing. Published on behalf of the European Society of Cardiology. All rights reserved.
RCT Entities:
BACKGROUND: Vessel wall injury after drug-eluting stent (DES) implantation can be characterized in detail by optical coherence tomography (OCT). Little is known about the healing course of these phenomena. METHODS AND RESULTS: In 62 lesions (62 patients), the incidence of acute vessel trauma was assessed in the stented region and the edge segments immediately after DES implantation. The healing course of these injuries was assessed at 9-month OCT follow-up using a software algorithm allowing for reliable spatial comparison of baseline and follow-up cross-sectional images. Tissue prolapse (TP) and tissue protrusions were detected in 81 and 35% of lesions, respectively. A total of 342 intra-stent dissection flaps (ISD) and 114 intra-stent dissection cavities (ISC) were visualized in 98 and 81% of lesions, respectively. Thirty-five lesions (56%) showed edge dissections (EDs). No residual TP or protrusion was observed at follow-up. Incomplete healing was seen in 8% of ISD and in 20% of ISC. For ED, a residual flap was observed in one-third of the initially dissected stent edges. Incomplete healing of acute vessel injury was associated with the presence of underlying atherosclerotic disease at baseline. Uncovered and malapposed stent struts were observed more often with incomplete healing of vessel injury at follow-up. CONCLUSIONS: Acute vessel wall trauma is highly prevalent immediately after DES implantation. Most of these injuries are minor and resolve at mid-term follow-up. Incomplete healing of ISDs seems to be associated with other OCT findings suggesting delayed arterial healing. Published on behalf of the European Society of Cardiology. All rights reserved.
Authors: Daisuke Nakamura; Guilherme F Attizzani; Setsu Nishino; Kentaro Tanaka; Mohamad Soud; Gabriel T Pereira; Milana Leygerman; Anas Fares; Audrey Schnell; Marco A Costa; Andrejs Erglis; Hiram G Bezerra Journal: Int J Cardiovasc Imaging Date: 2017-06-08 Impact factor: 2.357