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. (15th November 2016)

• Record Type: Journal Article
• Authors: Antonsen, Lisbeth; Thayssen, Per; Hansen, Henrik Steen; Junker, Anders; Veien, Karsten Tange; Hansen, Knud Nørregaard; Hougaard, Mikkel; Jensen, Lisette Okkels
• Is Part Of: International journal of cardiology. Volume 223(2016)
• Page Start: 466
• Page End: 474
• Publication Date: 2016-11-15
• Subjects: Optical coherence tomography -- Intravascular ultrasound -- Edge dissections -- Plaque morphology -- Drug-eluting stents; Cardiology -- Periodicals; Electronic journals; 616.12
• DOI: 10.1016/j.ijcard.2016.08.245
• Languages: English
• ISSNs: 0167-5273

Abstract

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.