Assessment by Optical Coherence Tomography of Stent Struts Across Side Branch

Liu, Yong; Imanishi, Toshio; Kubo, Takashi; Tanaka, Atsushi; Kitabata, Hironori; Tanimoto, Takashi; Ino, Yasushi; Ikejima, Hideyuki; Tsujioka, Hiroto; Komukai, Kenichi; Ishibashi, Keiichiro; Kashiwagi, Manabu; Ozaki, Yuichi; Hirata, Kumiko; Mizukoshi, Masato

doi:10.1253/circj.cj-10-0574

Cited by 35 publications

(21 citation statements)

References 19 publications

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“…A few previous OCT studies found insufficient neointimal coverage of jailing struts at the side-branch orifice, while struts attached to the vessel wall are well covered within the same DES. 9, 22 In the present bifurcation study, we observed a higher incidence of subclinical thrombus attachment (28/76 lesions, 36.8%) than has been reported for non-bifurcation lesions. 8 Also, the incidence of thrombus attachment at the side-branch orifice was significantly lower in the FKI group than in the non-FKI group.…”

Section: Local Determinants Of Intra-stent Thrombus At Bifurcationsupporting

confidence: 49%

Potential Benefit of Final Kissing Balloon Inflation After Single Stenting for the Treatment of Bifurcation Lesions

Hasegawa

Shinke

Otake

et al. 2013

Circ J

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Circulation Journal Official Journal of the Japanese Circulation Society http://www. j-circ.or.jp benefit of routine FKI after single stenting of bifurcation lesions. 6 In addition, inadequate side-branch dilatation may result in stent deformation or incomplete stent apposition. 7 In contrast, quantitative coronary angiography (QCA) conducted in the Nordic-Baltic Bifurcation Study III showed better expansion of the side-branch orifice in the FKI group. 6 Because delayed arterial healing characterized by exposed stent struts is considered a possible risk factor for stent thrombosis, 8 struts floating at the side-branch orifice (jailing strut) could affect thrombus formation after DES implantation. Despite these controversies, the relationship between stenting strategies and local findings, such as stent apposition, thrombus formation, and neointimal coverage, which may be associated with long-term clinical outcome, has not been well evaluated to date.Several studies have shown that the high resolution of optical coherence tomography (OCT) enables visualization of coronary arteries at the micron level for evaluation of strut coverercutaneous coronary intervention (PCI) using drugeluting stents (DES) reduces restenosis and major adverse cardiac events (MACE) compared to PCI with bare metal stents. 1 Even in the DES era, however, the procedures for bifurcation remain complex and challenging. 2,3 The single-stent strategy is currently considered preferable because the 2-stent strategy has higher rates of periprocedural myocardial infarction and long-term MACE, 4,5 which is probably associated with the increased use of contrast and prolonged procedure time. Therefore, a 1-stent strategy with a provisional approach to the side branch with final kissing inflation (FKI) might be the most acceptable strategy in clinical practice.Recently, the Nordic-Baltic Bifurcation Study III, a randomized comparison of clinical outcomes in patients with coronary bifurcation lesions treated with FKI vs. without FKI after main vessel (MV) stenting, found a similar 6-month clinical outcome between the 2 groups, raising questions regarding the Background: Treatment of coronary bifurcation lesions using a single stenting strategy is preferable over that using a 2-stent technique. The benefit of final kissing inflation (FKI), however, has not been established.

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Section: Local Determinants Of Intra-stent Thrombus At Bifurcationsupporting

confidence: 49%

Potential Benefit of Final Kissing Balloon Inflation After Single Stenting for the Treatment of Bifurcation Lesions

Hasegawa

Shinke

Otake

et al. 2013

Circ J

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“…11) Several studies have investigated the accuracy of quantitative OCT measurements. [12][13][14][15] When OCT was performed in a plexiglass phantom manufactured with a precision of 10 μm, the OCT measurement correlated extremely well with the real luminal dimension (relative standard deviation 1.8%, r = 1.000, intercept 0.01, slope 1.02). 4) In addition, OCT measurement demonstrated a high correlation with IVUS in vivo (R 2 = 0.82, P < 0.001).…”

Section: Discussionmentioning

confidence: 86%

Inter-Scan Reproducibility of Geometric Coronary Artery Measurements Using Frequency-Domain Optical Coherence Tomography

et al. 2013

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SummaryFrequency-domain optical coherence tomography (FD-OCT) is a novel technology which provides high-resolution cross-sectional images of coronary arteries. The aim of this study was to evaluate the inter-scan reproducibility of geometric FD-OCT measurements in the clinical setting. We examined 20 coronary lesions using FD-OCT. Following the FD-OCT image acquisition (1 st pullback), and after the disengagement and re-engagement of the guiding catheter, an additional acquisition (2 nd pullback) was performed using a new FD-OCT catheter. There was excellent correlation for minimum lumen area (r = 0.99, P < 0.001), lesion length (r = 0.99, P < 0.001) and lumen volume (r = 0.99, P < 0.001) between the 1 st pullback and the 2 nd pullback. The Bland-Altman test demonstrated good agreement between the 1 st pullback and the 2 nd pullback: the mean difference for minimum lumen area, lesion length, and lumen volume was 0.05 mm High frame rate (100 frame/sec) and fast pull-back speed (20 mm/s) of FD-OCT allow for a clear visualization of coronary lumens and vessel walls.2,3) Various factors such as location of the image catheter, heart motion, timing of image acquisition (systole/diastole) and manual zero-offset may affect the OCT assessment. 1) In vitro phantom models have demonstrated the accuracy of quantitative OCT measurement for luminal size and length. 4) In a Corelab setting, several studies have disclosed excellent intra-and inter-observer agreement of OCT measurements.5,6) However, the inter-scan reproducibility of geometric OCT measurements remains unclear. Such information in regard to measurement consistency between the scans should be required to design longitudinal OCT studies. The aim of the present study was to assess the inter-scan agreement for geometric FD-OCT measurements in a clinical setting. MethodsStudy population: We enrolled consecutive 20 patients who underwent percutaneous coronary intervention with a single stent for a native coronary artery lesion. Patients were excluded if they had congestive heart failure with a left ventricular ejection fraction < 30 %, renal insufficiency with baseline serum creatinine > 2.0 mg/dL, or required primary angioplasty. In addition, those with left main coronary artery stenting, ostial right coronary artery stenting, or bifurcation stenting were excluded because of expected difficulty in FD-OCT analysis. This protocol was approved by the Wakayama Medical University Ethics Committee, and all patients provided informed consent before participation.

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“…12- 14 Kyono et al 12 investigated 12,656 struts in 61 bifurcation segments (paclitaxel-eluting stent (PES): 16; sirolimus-eluting stent (SES): 14; zotarolimus-eluting stent (ZES): 23; BMS: 8) from 46 patients at 6 months after stent deployment. They found that PES had the highest prevalence of uncovered segments in the side-branch ostial region (PES 60.1, SES 17.0, ZES 13.2, BMS 12.3 (%), P<0.0001), whereas SES demonstrated the highest prevalence of uncovered segments opposite the ostial region (PES 3.3, SES 14.0, ZES 1.5, BMS 0.0 (%), P=0.0025).…”

Section: Article P 106mentioning

confidence: 99%

Neointimal Coverage Over Coronary Stent Struts Crossing the Side Branch Ostia

Sakata

2011

Circ J

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Circulation Journal Official Journal of the Japanese Circulation Society http://www. j-circ.or.jp ecently, the incidence of restenosis after percutaneous coronary intervention has been greatly reduced by the widespread use of drug-eluting stents (DES). 1 At the same time, however, safety concerns have been raised regarding the occurrence of late stent thrombosis (LST) after DES implantation. 2,3 Although the mechanism of LST has not yet been fully explained, pathological data from a registry totaling 81 human autopsies of DES recipients revealed that the most powerful histological predictor of stent thrombosis was the degree of endothelial coverage, and that the best morphometric predictor of LST was the ratio of uncovered to total stent struts. 4 Further, although the cases were collected before the DES era, a pathological analysis examining 13 cases with histological evidence of an acute occlusive or nonocclusive mural thrombus within a coronary stent in place ≥30days showed that stenting across ostia of major arterial branches (5 cases) and exposure to radiation therapy (3 cases) were the most frequent pathological mechanisms of LST. 5 Article p 106Previous and recent angioscopic studies have shown that neointimal coverage (NIC) over bare metal stents (BMS) is usually completed within 6 months, 6,7 but that NIC over DES is generally delayed. 8,9 Recent reports using optical coherence tomography (OCT) assessment revealed that the incidence of complete NIC was less than 30% at 9-12 months after DES implantation. 10,11 Accordingly, the lack or delay of NIC could be a possible explanation for the increased incidence of LST after DES implantation. DES at the site of side branches may be an especially high-risk combination for LST. In other words, stent struts placed across the ostia of the sidebranch vessels could be typical candidates for LST, because of delayed NIC. However, few published data regarding NIC in such regions have been available until very recently.Since 2011, several reports have demonstrated that variability among coronary stents in the strut coverage pattern assessed with OCT exists in the bifurcation. 12-14 Kyono et al 12 investigated 12,656 struts in 61 bifurcation segments (paclitaxel-eluting stent (PES): 16; sirolimus-eluting stent (SES): 14; zotarolimus-eluting stent (ZES): 23; BMS: 8) from 46 patients at 6 months after stent deployment. They found that PES had the highest prevalence of uncovered segments in the side-branch ostial region (PES 60.1, SES 17.0, ZES 13.2, BMS 12.3 (%), P<0.0001), whereas SES demonstrated the highest prevalence of uncovered segments opposite the ostial region (PES 3.3, SES 14.0, ZES 1.5, BMS 0.0 (%), P=0.0025). Her et al 13 evaluated the degree of NIC crossing the sidebranch vessel with OCT at 9.3 months after DES implantation. They found significant differences in the proportion of covered stents among the 3 DES types in 51 patients (6 (27%) of 22 with SES, 1 (7%) of 15 with PES, 8 (57%) of 14 with ZES; P=0.011). The percentage of NIC in the overall stent strut...

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Assessment by Optical Coherence Tomography of Stent Struts Across Side Branch

Cited by 35 publications

References 19 publications

Potential Benefit of Final Kissing Balloon Inflation After Single Stenting for the Treatment of Bifurcation Lesions

Potential Benefit of Final Kissing Balloon Inflation After Single Stenting for the Treatment of Bifurcation Lesions

Inter-Scan Reproducibility of Geometric Coronary Artery Measurements Using Frequency-Domain Optical Coherence Tomography

Neointimal Coverage Over Coronary Stent Struts Crossing the Side Branch Ostia

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