Correlation of angiographic late loss with neointimal coverage of drug-eluting stent struts on follow-up optical coherence tomography

  • Byeong-Keuk Kim
  • Jung-Sun Kim
  • Young-Guk Ko
  • Donghoon Choi
  • Yangsoo Jang
  • Myeong-Ki Hong
Original Paper
First Online:
Received:
Accepted:

Abstract

Minimal data have been published on the correlation between angiographic late loss (LL) and incomplete neointimal coverage of struts after drug-eluting stent (DES) implantation. Therefore, we evaluated the relationship between angiographic LL and the percentage of uncovered struts on follow-up optical coherence tomography (OCT) images, in all cross-sections of the lesions. From the OCT registry database, 219 lesions without restenosis after DES implantation were divided into tertiles based on angiographic LL: tertile I (LL ≤ 0.26 mm), tertile II (0.26 < LL < 0.59 mm), and tertile III (≥0.59 mm). Lesions with the percentage of uncovered struts in the highest quartile (≥75th percentile; >6.0%) were defined as highly uncovered; in an independent analysis, lesions without any uncovered strut(s) were defined as completely covered. Higher percentages of uncovered struts were observed in tertile I than in both tertile II and III (10.3 ± 12.8% vs. 4.2 ± 7.4% vs. 2.4 ± 5.1%, respectively; P < 0.001 for I vs. II and I vs. III). Angiographic LL correlated significantly with the percentage of uncovered struts on OCT (r = −0.340, P < 0.001). The best cut-off values of angiographic LL to predict highly uncovered and completely covered lesions were 0.29 mm (area under curves [AUC] = 0.723, P < 0.001) and 0.61 mm (AUC = 0.692, P < 0.001), respectively. Angiographic LL inversely and significantly correlated with the percentage of uncovered struts on OCT after DES implantation.

Keywords

Coronary artery disease Optical coherence tomography Stent 
This is a preview of subscription content, log in to check access.

Notes

Acknowledgments

This study was partly supported by grants from the Korea Healthcare Technology R&D Project, Ministry for Health, Welfare & Family Affairs, Republic of Korea (No. A085012 and A102064), the Korea Health 21 R&D Project, Ministry of Health & Welfare, Republic of Korea (No. A085136), and the Cardiovascular Research Center, Seoul, Korea.

Conflict of interest

None.

References

  1. 1.
    Iakovou I, Schmidt T, Bonizzoni E, Ge L, Sangiorgi GM, Stankovic G, Airoldi F, Chieffo A, Montorfano M, Carlino M, Michev I, Corvaja N, Briguori C, Gerckens U, Grube E, Colombo A (2005) Incidence, predictors, and outcome of thrombosis after successful implantation of drug-eluting stents. JAMA 293:2126–2130PubMedCrossRefGoogle Scholar
  2. 2.
    Daemen J, Wenaweser P, Tsuchida K, Abrecht L, Vaina S, Morger C, Kukreja N, Jüni P, Sianos G, Hellige G, van Domburg RT, Hess OM, Boersma E, Meier B, Windecker S, Serruys PW (2007) Early and late coronary stent thrombosis of sirolimus-eluting and paclitaxel-eluting stents in routine clinical practice: data from a large two-institutional cohort study. Lancet 369:667–678PubMedCrossRefGoogle Scholar
  3. 3.
    Ellis SG, Popma JJ, Lasala JM, Koglin JJ, Cox DA, Hermiller J, O’shaughnessy C, Mann JT, Turco M, Caputo R, Bergin P, Greenberg J, Stone GW (2005) Relationship between angiographic late loss and target lesion revascularization after coronary stent implantation: analysis from the TAXUS-IV trial. J Am Coll Cardiol 45:1193–1200PubMedCrossRefGoogle Scholar
  4. 4.
    Mauri L, Orav EJ, Kuntz RE (2005) Late loss in lumen diameter and binary restenosis for drug-eluting stent comparison. Circulation 111:3435–3442PubMedCrossRefGoogle Scholar
  5. 5.
    Mauri L, Orav EJ, Candia SC, Cutlip DE, Kuntz RE (2005) Robustness of late lumen loss in discriminating drug-eluting stents across variable observational and randomized trials. Circulation 112:2833–2839PubMedCrossRefGoogle Scholar
  6. 6.
    Moreno R, Fernandez C, Sanchez-Recalde A, Galeote G, Calvo L, Alfonso F, Hernandez R, Sánchez-Aquino R, Angiolillo DJ, Villarreal S, Macaya C, Lopez-Sendon JL (2007) Clinical impact of in-stent late loss after drug-eluting coronary stent implantation. Eur Heart J 28:1583–1591PubMedCrossRefGoogle Scholar
  7. 7.
    Pocock SJ, Lansky AJ, Mehran R, Popma JJ, Fahy MP, Na Y, Dangas G, Moses JW, Pucelikova T, Kandzari DE, Ellis SG, Leon MB, Stone GW (2008) Angiographic surrogate end points in drug-eluting stent trials: a systematic evaluation based on individual patient data from 11 randomized, controlled trials. J Am Coll Cardiol 51:23–32PubMedCrossRefGoogle Scholar
  8. 8.
    Farb A, Burke AP, Kolodgie FD, Virmani R (2003) Pathological mechanisms of fatal late coronary stent thrombosis in humans. Circulation 108:1701–1706PubMedCrossRefGoogle Scholar
  9. 9.
    Finn AV, Joner M, Nakazawa G, Kolodgie F, Newell J, John MC, Gold HK, Virmani R (2007) Pathological correlates of late drug-eluting stent thrombosis: strut coverage as a marker of endothelialization. Circulation 115:2435–2441PubMedCrossRefGoogle Scholar
  10. 10.
    Takano M, Inami S, Jang IK, Yamamoto M, Murakami D, Seimiya K, Ohba T, Mizuno K (2007) Evaluation by optical coherence tomography of neointimal coverage of sirolimus-eluting stent three months after implantation. Am J Cardiol 99:1033–1038PubMedCrossRefGoogle Scholar
  11. 11.
    Guagliumi G, Sirbu V (2008) Optical coherence tomography: high resolution intravascular imaging to evaluate vascular healing after coronary stenting. Catheter Cardiovasc Interv 72:237–247PubMedCrossRefGoogle Scholar
  12. 12.
    Takano M, Yamamoto M, Inami S, Murakami D, Seimiya K, Ohba T, Seino Y, Mizuno K (2008) Long-term follow-up evaluation after sirolimus-eluting stent implantation by optical coherence tomography: do uncovered struts persist? J Am Coll Cardiol 51:968–969PubMedCrossRefGoogle Scholar
  13. 13.
    Kim JS, Jang IK, Kim JS, Kim TH, Takano M, Kume T, Hur NW, Ko YG, Choi D, Hong MK, Jang Y (2009) Optical coherence tomography evaluation of zotarolimus-eluting stents at 9-month follow-up: comparison with sirolimus-eluting stents. Heart 95:1907–1912PubMedCrossRefGoogle Scholar
  14. 14.
    Chen BX, Ma FY, Luo W, Ruan JH, Xie WL, Zhao XZ, Sun SH, Guo XM, Wang F, Tian T, Chu XW (2008) Neointimal coverage of bare-metal and sirolimus-eluting stents evaluated with optical coherence tomography. Heart 94:566–570PubMedCrossRefGoogle Scholar
  15. 15.
    Prati F, Regar E, Mintz GS, Arbustini E, Di Mario C, Jang IK, Akasaka T, Costa M, Guagliumi G, Grube E, Ozaki Y, Pinto F, Serruys PW (2010). Expert review document on methodology, terminology, and clinical applications of optical coherence tomography: physical principles, methodology of image acquisition, and clinical application for assessment of coronary arteries and atherosclerosis. Eur Heart J 31:401–415 (For the expert’s OCT review document)Google Scholar
  16. 16.
    Barlis P, Dimopoulos K, Tanigawa J, Dzielicka E, Ferrante G, Del Furia F, Di Mario C (2010) Quantitative analysis of intracoronary optical coherence tomography measurements of stent strut apposition and tissue coverage. Int J Cardiol 141:151–156PubMedCrossRefGoogle Scholar
  17. 17.
    Kume T, Akasaka T, Kawamoto T, Ogasawara Y, Watanabe N, Toyota E, Neishi Y, Sukmawan R, Sadahira Y, Yoshida K (2006) Assessment of coronary arterial thrombus by optical coherence tomography. Am J Cardiol 97:1713–1717PubMedCrossRefGoogle Scholar
  18. 18.
    Camenzind E, Steg PG, Wijns W (2007) Stent thrombosis late after implantation of first-generation drug-eluting stents: a cause for concern. Circulation 115:1440–1455PubMedCrossRefGoogle Scholar
  19. 19.
    Rivero F, Moreno R, Barreales L, Galeote G, Sánchez-Recalde A, Calvo L, Jimenez-Valero S, Villate A, Vanegas M, López-Sendón JL (2008) Lower levels of in-stent late loss are not associated with the risk of stent thrombosis in patients receiving drug-eluting stents. EuroIntervention 4:124–132PubMedCrossRefGoogle Scholar
  20. 20.
    Kim JS, Hong MK, Fan C, Kim TH, Shim JM, Park SM, Ko YG, Choi D, Jang Y (2010) Intracoronary thrombus formation after drug-eluting stents implantation: optical coherence tomographic study. Am Heart J 159:278–283PubMedCrossRefGoogle Scholar
  21. 21.
    Garg P, Cohen DJ, Gaziano T, Mauri L (2008) Balancing the risks of restenosis and stent thrombosis in bare-metal versus drug-eluting stents: results of a decision analytic model. J Am Coll Cardiol 51:1844–1853PubMedCrossRefGoogle Scholar

Copyright information

© Springer Science+Business Media, B.V. 2011

Authors and Affiliations

  • Byeong-Keuk Kim
    • 1
  • Jung-Sun Kim
    • 1
  • Young-Guk Ko
    • 1
  • Donghoon Choi
    • 1
  • Yangsoo Jang
    • 1
    • 2
  • Myeong-Ki Hong
    • 1
    • 2
  1. 1.Division of Cardiology, Severance Cardiovascular HospitalYonsei University College of MedicineSeoulKorea
  2. 2.Severance Biomedical Science InstituteYonsei University College of MedicineSeoulKorea

Personalised recommendations