Abstract
Patients with type 2 diabetes are at increased risk for post-PCI complications including stent thrombosis and restenosis. Stent edge dissections (SEDs) have been associated with these complications. This study assessed incidence and predictors of SEDs in patients with type 2 diabetes using optical coherence tomography (OCT). Intravascular lesion parameters and plaque morphology were investigated pre- and post-PCI using OCT in 73 type 2 diabetic patients with 90 lesions and 166 visible stent edges. We detected 42 (25.3 %) SEDs in 166 stent edges and 37 (41.1 %) SEDs in 90 lesions. More SEDs occurred if the border of the stent had been placed within diseased vessel segments with predominantly fibrous (42.9 %) and fibrocalcific (40.5 %) plaques compared to healthy vessel wall morphology (p < 0.001). Furthermore, the lumen eccentricity of the stent at its edges (SAE) (16.00 ± 6.07 vs. 13.11 ± 5.22 %, p < 0.003) and the stent-edge-to-lumen-area-ratio (1.26 ± 0.27 vs. 0.99 ± 0.20, p < 0.001) were both significantly larger in the presence of SEDs. All of the above parameters were significant predictors for SEDs on uni- and multivariate logistic regression analysis (all p < 0.01), suggesting that the lumen eccentricity of the SAE, the stent-edge-to-lumen-area-ratio and diseased vessel wall morphology of the reference segment adjacent to the stent edge are independent risk factors for the presence of SEDs. These results suggest that diseased vessel wall morphology at the stent edges may promote the occurrence of SEDs and that avoidance of longitudinal and transverse mismatch between stent and vessel could be important to reduce SEDs in cardiovascular high-risk patients with type 2 diabetes.
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Rogers JH, Lasala JM (2004) Coronary artery dissection and perforation complicating percutaneous coronary intervention. J Invasive Cardiol 16(9):493–499
Biondi-Zoccai GG, Agostoni P, Sangiorgi GM, Airoldi F, Cosgrave J, Chieffo A, Barbagallo R, Tamburino C, Vittori G, Falchetti E, Margheri M, Briguori C, Remigi E, Iakovou I, Colombo A (2006) Incidence, predictors, and outcomes of coronary dissections left untreated after drug-eluting stent implantation. Eur Heart J 27(5):540–546. doi:10.1093/eurheartj/ehi618
Holmes DR Jr, Holubkov R, Vlietstra RE, Kelsey SF, Reeder GS, Dorros G, Williams DO, Cowley MJ, Faxon DP, Kent KM et al (1988) Comparison of complications during percutaneous transluminal coronary angioplasty from 1977 to 1981 and from 1985 to 1986: the National Heart, Lung, and Blood Institute Percutaneous Transluminal Coronary Angioplasty Registry. J Am Coll Cardiol 12(5):1149–1155
Cutlip DE, Baim DS, Ho KK, Popma JJ, Lansky AJ, Cohen DJ, Carrozza JP Jr, Chauhan MS, Rodriguez O, Kuntz RE (2001) Stent thrombosis in the modern era: a pooled analysis of multicenter coronary stent clinical trials. Circulation 103(15):1967–1971
Hong MK, Park SW, Lee NH, Nah DY, Lee CW, Kang DH, Song JK, Kim JJ, Park SJ (2000) Long-term outcomes of minor dissection at the edge of stents detected with intravascular ultrasound. Am J Cardiol 86 (7):791–795, A799
Kip KE, Faxon DP, Detre KM, Yeh W, Kelsey SF, Currier JW (1996) Coronary angioplasty in diabetic patients. The national heart, lung, and blood institute percutaneous transluminal coronary angioplasty registry. Circulation 94(8):1818–1825
Beckman JA, Creager MA, Libby P (2002) Diabetes and atherosclerosis: epidemiology, pathophysiology, and management. JAMA 287(19):2570–2581
Malmberg K, Yusuf S, Gerstein HC, Brown J, Zhao F, Hunt D, Piegas L, Calvin J, Keltai M, Budaj A (2000) Impact of diabetes on long-term prognosis in patients with unstable angina and non-Q-wave myocardial infarction: results of the OASIS (Organization to Assess Strategies for Ischemic Syndromes) Registry. Circulation 102(9):1014–1019
Investigators TB (1997) Influence of diabetes on 5-year mortality and morbidity in a randomized trial comparing CABG and PTCA in patients with multivessel disease: the Bypass Angioplasty Revascularization Investigation (BARI). Circulation 96(6):1761–1769
Feng T, Yundai C, Lian C, Zhijun S, Changfu L, Jun G, Hongbin L (2010) Assessment of coronary plaque characteristics by optical coherence tomography in patients with diabetes mellitus complicated with unstable angina pectoris. Atherosclerosis 213(2):482–485. doi:10.1016/j.atherosclerosis.2010.09.019
Kume T, Okura H, Miyamoto Y, Yamada R, Saito K, Tamada T, Koyama T, Neishi Y, Hayashida A, Kawamoto T, Yoshida K (2012) Natural history of stent edge dissection, tissue protrusion and incomplete stent apposition detectable only on optical coherence tomography after stent implantation: preliminary observation. Circ J 76(3):698–703
Gonzalo N, Serruys PW, Okamura T, Shen ZJ, Garcia–Garcia HM, Onuma Y, van Geuns RJ, Ligthart J, Regar E (2011) Relation between plaque type and dissections at the edges after stent implantation: an optical coherence tomography study. Int J Cardiol 150(2):151–155. doi:10.1016/j.ijcard.2010.03.006
Guo J, Chen YD, Tian F, Liu HB, Chen L, Sun ZJ, Ren YH, Jin QH, Liu CF, Han BS, Gai LY, Yang TS (2012) Optical coherence tomography assessment of edge dissections after drug-eluting stent implantation in coronary artery. Chin Med J (Engl) 125(6):1047–1050
Tearney GJ, Regar E, Akasaka T, Adriaenssens T, Barlis P, Bezerra HG, Bouma B, Bruining N, Cho JM, Chowdhary S, Costa MA, de Silva R, Dijkstra J, Di Mario C, Dudek D, Falk E, Feldman MD, Fitzgerald P, Garcia–Garcia HM, Gonzalo N, Granada JF, Guagliumi G, Holm NR, Honda Y, Ikeno F, Kawasaki M, Kochman J, Koltowski L, Kubo T, Kume T, Kyono H, Lam CC, Lamouche G, Lee DP, Leon MB, Maehara A, Manfrini O, Mintz GS, Mizuno K, Morel MA, Nadkarni S, Okura H, Otake H, Pietrasik A, Prati F, Raber L, Radu MD, Rieber J, Riga M, Rollins A, Rosenberg M, Sirbu V, Serruys PW, Shimada K, Shinke T, Shite J, Siegel E, Sonoda S, Suter M, Takarada S, Tanaka A, Terashima M, Thim T, Uemura S, Ughi GJ, van Beusekom HM, van der Steen AF, van Es GA, van Soest G, Virmani R, Waxman S, Weissman NJ, Weisz G (2012) Consensus standards for acquisition, measurement, and reporting of intravascular optical coherence tomography studies: a report from the International Working Group for Intravascular Optical Coherence Tomography Standardization and Validation. J Am Coll Cardiol 59(12):1058–1072. doi:10.1016/j.jacc.2011.09.079
Jang IK, Tearney GJ, MacNeill B, Takano M, Moselewski F, Iftima N, Shishkov M, Houser S, Aretz HT, Halpern EF, Bouma BE (2005) In vivo characterization of coronary atherosclerotic plaque by use of optical coherence tomography. Circulation 111(12):1551–1555
Yabushita H, Bouma BE, Houser SL, Aretz HT, Jang IK, Schlendorf KH, Kauffman CR, Shishkov M, Kang DH, Halpern EF, Tearney GJ (2002) Characterization of human atherosclerosis by optical coherence tomography. Circulation 106(13):1640–1645
Choi SY, Witzenbichler B, Maehara A, Lansky AJ, Guagliumi G, Brodie B, Kellett MA Jr, Dressler O, Parise H, Mehran R, Dangas GD, Mintz GS, Stone GW (2011) Intravascular ultrasound findings of early stent thrombosis after primary percutaneous intervention in acute myocardial infarction: a Harmonizing Outcomes with Revascularization and Stents in Acute Myocardial Infarction (HORIZONS-AMI) substudy. Circ Cardiovasc Interv 4(3):239–247. doi:10.1161/CIRCINTERVENTIONS.110.959791
Sheris SJ, Canos MR, Weissman NJ (2000) Natural history of intravascular ultrasound-detected edge dissections from coronary stent deployment. Am Heart J 139(1 Pt 1):59–63
Liu X, Tsujita K, Maehara A, Mintz GS, Weisz G, Dangas GD, Lansky AJ, Kreps EM, Rabbani LE, Collins M, Stone GW, Moses JW, Mehran R, Leon MB (2009) Intravascular ultrasound assessment of the incidence and predictors of edge dissections after drug-eluting stent implantation. JACC Cardiovasc Interv 2(10):997–1004. doi:10.1016/j.jcin.2009.07.012
Uren NG, Schwarzacher SP, Metz JA, Lee DP, Honda Y, Yeung AC, Fitzgerald PJ, Yock PG (2002) Predictors and outcomes of stent thrombosis: an intravascular ultrasound registry. Eur Heart J 23(2):124–132. doi:10.1053/euhj.2001.2707
Nishida T, Colombo A, Briguori C, Stankovic G, Albiero R, Corvaja N, Finci L, Di Mario C, Tobis JM (2002) Outcome of nonobstructive residual dissections detected by intravascular ultrasound following percutaneous coronary intervention. Am J Cardiol 89(11):1257–1262
Morgan KP, Kapur A, Beatt KJ (2004) Anatomy of coronary disease in diabetic patients: an explanation for poorer outcomes after percutaneous coronary intervention and potential target for intervention. Heart 90(7):732–738. doi:10.1136/hrt.2003.021014
Burke AP, Kolodgie FD, Zieske A, Fowler DR, Weber DK, Varghese PJ, Farb A, Virmani R (2004) Morphologic findings of coronary atherosclerotic plaques in diabetics: a postmortem study. Arterioscler Thromb Vasc Biol 24(7):1266–1271. doi:10.1161/01.ATV.0000131783.74034.97
Costa MA, Angiolillo DJ, Tannenbaum M, Driesman M, Chu A, Patterson J, Kuehl W, Battaglia J, Dabbons S, Shamoon F, Flieshman B, Niederman A, Bass TA (2008) Impact of stent deployment procedural factors on long-term effectiveness and safety of sirolimus-eluting stents (final results of the multicenter prospective STLLR trial). Am J Cardiol 101(12):1704–1711. doi:10.1016/j.amjcard.2008.02.053
D’Ascenzo F, Bollati M, Clementi F, Castagno D, Lagerqvist B, de la Torre Hernandez JM, Ten Berg JM, Brodie BR, Urban P, Jensen LO, Sardi G, Waksman R, Lasala JM, Schulz S, Stone GW, Airoldi F, Colombo A, Lemesle G, Applegate RJ, Buonamici P, Kirtane AJ, Undas A, Sheiban I, Gaita F, Sangiorgi G, Modena MG, Frati G, Biondi-Zoccai G (2012) Incidence and predictors of coronary stent thrombosis: evidence from an international collaborative meta-analysis including 30 studies, 221,066 patients, and 4276 thromboses. Int J Cardiol. doi:10.1016/j.ijcard.2012.01.080
Steinberg DH, Mintz GS, Mandinov L, Yu A, Ellis SG, Grube E, Dawkins KD, Ormiston J, Turco MA, Stone GW, Weissman NJ (2010) Long-term impact of routinely detected early and late incomplete stent apposition: an integrated intravascular ultrasound analysis of the TAXUS IV, V, and VI and TAXUS ATLAS workhorse, long lesion, and direct stent studies. JACC Cardiovasc Interv 3(5):486–494. doi:10.1016/j.jcin.2010.03.007
Acknowledgments
This work was supported by grants from the Interdisciplinary Centre for Clinical Research within the faculty of Medicine at the RWTH Aachen University, the German Heart Foundation/German Foundation of Heart Research and the Ernst and Berta Grimmke-Stiftung to Dr. Mathias Burgmaier. We thank Martin Meynberg for graphical assistance.
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Reith, S., Battermann, S., Jaskolka, A. et al. Predictors and incidence of stent edge dissections in patients with type 2 diabetes as determined by optical coherence tomography. Int J Cardiovasc Imaging 29, 1237–1247 (2013). https://doi.org/10.1007/s10554-013-0213-y
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DOI: https://doi.org/10.1007/s10554-013-0213-y