AIMS: Vascular calcification is routinely encountered in percutaneous coronary intervention (PCI) and severe coronary calcification is a known predictor of in-stent restenosis and stent thrombosis. However, the histopathologic mechanisms behind such events have not been systematically described. METHODS AND RESULTS: From our registry of 1211 stents, a total of 134 newer-generation drug-eluting stents (DES) (Xience, Resolute-Integrity, PROMUS-Element, and Synergy) with duration of implant ≥30 days were histologically analysed. The extent of calcification of the stented lesions was evaluated radiographically and divided into severe (SC, n = 46) and non-severely calcified lesions (NC, n = 88). The percent-uncovered struts per section {SC vs. NC; median 2.4 [interquartile range (IQR) 0.0-19.0] % vs. 0.0 (IQR 0.0-4.6) %, P = 0.02} and the presence of severe medial tears (MTs) (59% vs. 44%, respectively, P = 0.03) were greater in SC than NC. In addition, SC had a higher prevalence of ≥3 consecutive struts lying directly in contact with surface calcified area (3SC) (52% vs. 8%, respectively, P < 0.0001). Multivariate analysis demonstrated that sections with duration of implantation ≤6 months [odds ratio (OR): 7.7, P < 0.0001], 3SC (OR: 6.5, P < 0.0001), strut malapposition (OR: 5.0, P < 0.0001), and lack of MTs (OR: 2.5, P = 0.0005) were independent predictors of uncovered struts. Prevalence of neoatherosclerosis was significantly lower in SC than that of NC (24% vs. 44%, P = 0.02). CONCLUSION: Severe calcification, especially surface calcified area is an independent predictor of uncovered struts and delayed healing after newer-generation DES implantation. These data expand of knowledge of the vascular responses of stenting of calcified arteries and suggests further understand of how best to deal with calcification in patients undergoing PCI. Published on behalf of the European Society of Cardiology. All rights reserved.
AIMS: Vascular calcification is routinely encountered in percutaneous coronary intervention (PCI) and severe coronary calcification is a known predictor of in-stent restenosis and stent thrombosis. However, the histopathologic mechanisms behind such events have not been systematically described. METHODS AND RESULTS: From our registry of 1211 stents, a total of 134 newer-generation drug-eluting stents (DES) (Xience, Resolute-Integrity, PROMUS-Element, and Synergy) with duration of implant ≥30 days were histologically analysed. The extent of calcification of the stented lesions was evaluated radiographically and divided into severe (SC, n = 46) and non-severely calcified lesions (NC, n = 88). The percent-uncovered struts per section {SC vs. NC; median 2.4 [interquartile range (IQR) 0.0-19.0] % vs. 0.0 (IQR 0.0-4.6) %, P = 0.02} and the presence of severe medial tears (MTs) (59% vs. 44%, respectively, P = 0.03) were greater in SC than NC. In addition, SC had a higher prevalence of ≥3 consecutive struts lying directly in contact with surface calcified area (3SC) (52% vs. 8%, respectively, P < 0.0001). Multivariate analysis demonstrated that sections with duration of implantation ≤6 months [odds ratio (OR): 7.7, P < 0.0001], 3SC (OR: 6.5, P < 0.0001), strut malapposition (OR: 5.0, P < 0.0001), and lack of MTs (OR: 2.5, P = 0.0005) were independent predictors of uncovered struts. Prevalence of neoatherosclerosis was significantly lower in SC than that of NC (24% vs. 44%, P = 0.02). CONCLUSION: Severe calcification, especially surface calcified area is an independent predictor of uncovered struts and delayed healing after newer-generation DES implantation. These data expand of knowledge of the vascular responses of stenting of calcified arteries and suggests further understand of how best to deal with calcification in patients undergoing PCI. Published on behalf of the European Society of Cardiology. All rights reserved.
Authors: Tullio Palmerini; Umberto Benedetto; Giuseppe Biondi-Zoccai; Diego Della Riva; Letizia Bacchi-Reggiani; Pieter C Smits; Georgios J Vlachojannis; Lisette Okkels Jensen; Evald H Christiansen; Klára Berencsi; Marco Valgimigli; Carlotta Orlandi; Mario Petrou; Claudio Rapezzi; Gregg W Stone Journal: J Am Coll Cardiol Date: 2015-06-16 Impact factor: 24.094
Authors: Marco Valgimigli; Héctor Bueno; Robert A Byrne; Jean-Philippe Collet; Francesco Costa; Anders Jeppsson; Peter Jüni; Adnan Kastrati; Philippe Kolh; Laura Mauri; Gilles Montalescot; Franz-Josef Neumann; Mate Petricevic; Marco Roffi; Philippe Gabriel Steg; Stephan Windecker; Jose Luis Zamorano; Glenn N Levine Journal: Eur Heart J Date: 2018-01-14 Impact factor: 29.983
Authors: Juhani Knuuti; William Wijns; Antti Saraste; Davide Capodanno; Emanuele Barbato; Christian Funck-Brentano; Eva Prescott; Robert F Storey; Christi Deaton; Thomas Cuisset; Stefan Agewall; Kenneth Dickstein; Thor Edvardsen; Javier Escaned; Bernard J Gersh; Pavel Svitil; Martine Gilard; David Hasdai; Robert Hatala; Felix Mahfoud; Josep Masip; Claudio Muneretto; Marco Valgimigli; Stephan Achenbach; Jeroen J Bax Journal: Eur Heart J Date: 2020-01-14 Impact factor: 29.983
Authors: Aloke V Finn; Michael Joner; Gaku Nakazawa; Frank Kolodgie; John Newell; Mike C John; Herman K Gold; Renu Virmani Journal: Circulation Date: 2007-04-16 Impact factor: 29.690
Authors: Gaku Nakazawa; Aloke V Finn; Marc Vorpahl; Elena Ladich; Robert Kutys; Isidora Balazs; Frank D Kolodgie; Renu Virmani Journal: J Am Coll Cardiol Date: 2009-11-17 Impact factor: 24.094
Authors: Borja Ibanez; Stefan James; Stefan Agewall; Manuel J Antunes; Chiara Bucciarelli-Ducci; Héctor Bueno; Alida L P Caforio; Filippo Crea; John A Goudevenos; Sigrun Halvorsen; Gerhard Hindricks; Adnan Kastrati; Mattie J Lenzen; Eva Prescott; Marco Roffi; Marco Valgimigli; Christoph Varenhorst; Pascal Vranckx; Petr Widimský Journal: Eur Heart J Date: 2018-01-07 Impact factor: 29.983
Authors: Gaku Nakazawa; Aloke V Finn; Michael Joner; Elena Ladich; Robert Kutys; Erik K Mont; Herman K Gold; Allen P Burke; Frank D Kolodgie; Renu Virmani Journal: Circulation Date: 2008-08-25 Impact factor: 29.690
Authors: Tom Adriaenssens; Michael Joner; Thea C Godschalk; Nikesh Malik; Fernando Alfonso; Erion Xhepa; Dries De Cock; Kenichi Komukai; Tomohisa Tada; Javier Cuesta; Vasile Sirbu; Laurent J Feldman; Franz-Josef Neumann; Alison H Goodall; Ton Heestermans; Ian Buysschaert; Ota Hlinomaz; Ann Belmans; Walter Desmet; Jurrien M Ten Berg; Anthony H Gershlick; Steffen Massberg; Adnan Kastrati; Giulio Guagliumi; Robert A Byrne Journal: Circulation Date: 2017-07-18 Impact factor: 29.690
Authors: Christopher Noble; Kent D Carlson; Erica Neumann; Bradley Lewis; Dan Dragomir-Daescu; Amir Lerman; Ahmet Erdemir; Melissa D Young Journal: J Mech Behav Biomed Mater Date: 2021-10-30