Sining Hu1, Chao Wang1, Chunyang Zhe1, Yinchun Zhu1, Taishi Yonetsu2, Haibo Jia1, Jingbo Hou1, Shaosong Zhang1, Ik-Kyung Jang3, Bo Yu1. 1. Department of Cardiology, The Second Affiliated Hospital of Harbin Medical University, The Key Laboratory of Myocardial Ischemia, Chinese Ministry of Education, Harbin, China. 2. Division of Cardiovascular Medicine, Tsuchiura Kyodo General Hospital, Ibaraki, Japan. 3. Cardiology Division, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts.
Abstract
OBJECTIVES: To compare vascular healing after drug-eluting stent (DES) implantation between plaque rupture (PR) and plaque erosion (PE). BACKGROUND: Vascular response after stent implantation in patients with PR has been extensively studied. Little is known about vascular healing after stent implantation in PE. METHODS: Sixty-five ACS patients who received optical coherence tomography (OCT) imaging of the culprit lesions both before and after stent implantation at baseline as well as at 6 months were included in this study. Patients were divided into two groups: PR (n = 19) and PE (n = 24). Prestent thrombus burden and poststent intrastent structure (ISS) volume were analyzed during the index procedure. The ratio of uncovered to total stent struts per cross-section score (RUTTS) and neointimal thickness and area were measured at follow-up. RESULTS: OCT imaging showed that compared with PR, PE showed a significantly lower prestent thrombus score (34.2 ± 19.2 vs. 68.6 ± 44.2, P = 0.009) at baseline and a smaller poststent ISS volume (0.7 ± 0.9 mm3 vs. 2.1 ± 1.9 mm3 , P = 0.019). At the 6-month follow-up, PE showed a higher incidence of RUTTS >0.3 (12.2 ± 14.4 vs. 2.0 ± 4.5%, P = 0.003), thinner neointimal thickness (0.05 ± 0.02 mm vs. 0.12 ± 0.08 mm, P = 0.002), and smaller neointimal area (0.5 ± 0.2 vs. 1.2 ± 0.9 mm2 , P = 0.004) compared with PR. In a multivariate logistic model, PE was identified as an independent predictor for RUTTS >0.3. CONCLUSIONS: PE was associated with less favorable healing following DES implantation when compared to PR at 6 months, indicating longer dual-antiplatelet therapy may be necessary for patients with PE.
OBJECTIVES: To compare vascular healing after drug-eluting stent (DES) implantation between plaque rupture (PR) and plaque erosion (PE). BACKGROUND: Vascular response after stent implantation in patients with PR has been extensively studied. Little is known about vascular healing after stent implantation in PE. METHODS: Sixty-five ACS patients who received optical coherence tomography (OCT) imaging of the culprit lesions both before and after stent implantation at baseline as well as at 6 months were included in this study. Patients were divided into two groups: PR (n = 19) and PE (n = 24). Prestent thrombus burden and poststent intrastent structure (ISS) volume were analyzed during the index procedure. The ratio of uncovered to total stent struts per cross-section score (RUTTS) and neointimal thickness and area were measured at follow-up. RESULTS: OCT imaging showed that compared with PR, PE showed a significantly lower prestent thrombus score (34.2 ± 19.2 vs. 68.6 ± 44.2, P = 0.009) at baseline and a smaller poststent ISS volume (0.7 ± 0.9 mm3 vs. 2.1 ± 1.9 mm3 , P = 0.019). At the 6-month follow-up, PE showed a higher incidence of RUTTS >0.3 (12.2 ± 14.4 vs. 2.0 ± 4.5%, P = 0.003), thinner neointimal thickness (0.05 ± 0.02 mm vs. 0.12 ± 0.08 mm, P = 0.002), and smaller neointimal area (0.5 ± 0.2 vs. 1.2 ± 0.9 mm2 , P = 0.004) compared with PR. In a multivariate logistic model, PE was identified as an independent predictor for RUTTS >0.3. CONCLUSIONS:PE was associated with less favorable healing following DES implantation when compared to PR at 6 months, indicating longer dual-antiplatelet therapy may be necessary for patients with PE.
Authors: Chinmay Khandkar; Mahesh V Madhavan; James C Weaver; David S Celermajer; Keyvan Karimi Galougahi Journal: Cells Date: 2021-04-10 Impact factor: 6.600