Comparison of post‐stent optical coherence tomography findings: Layered versus non‐layered culprit lesions

Abstract

Objectives This study aimed to investigate the vascular response of lesions with a layered phenotype. Background Recent studies have shown that layered plaques at culprit lesions detected by optical coherence tomography (OCT) have greater plaque burden and more inflammatory features than non‐layered plaques. Methods This is a retrospective observational study. A total of 193 target lesions from 193 patients [100 patients with acute coronary syndromes (ACS) and 93 with stable angina pectoris (SAP)] who had undergone OCT imaging of the culprit lesion both before and after stenting were included. Layered plaques were identified by OCT as plaques with layers of different optical density. Patients were divided into two groups based on the presence or absence of a layered phenotype at the culprit lesion, and pre‐ and post‐procedure OCT findings were compared. Results Among 193 patients, 36 (36.0%) lesions in ACS patients and 56 (60.2%) lesions in SAP patients were found to have a layered phenotype at the culprit lesion. At baseline, percent area stenosis was greater in layered plaque than in non‐layered plaque (p = .019). Following stent implantation, the stent expansion ratio and mean stent eccentricity index were significantly lower in layered plaques than in non‐layered plaques (p = .041, p = .017, respectively), mainly derived from ACS patients. Conclusion Following stent implantation, plaques with a layered phenotype had less stent expansion and more eccentric lumens. Aggressive balloon dilation may be required to obtain optimal stent outcomes in patients with a layered plaque phenotype at the culprit lesion.

Prevalence of Healed Plaque and Factors Influencing Its Characteristics Under Optical Coherence Tomography in Patients With Coronary Artery Disease: A Systematic Review, Meta-Analysis, and Meta-Regression

“…In the clinical therapeutic interventions, Kurihara et al found that stents had limited dilation and more eccentric lumens in non-healed plaques after PCI in patients with ACS compared with healed plaques. Afterward, they found that the presence of healed plaques in culprit vessels was an independent predictor of revascularization rate during a 2-year follow-up ( 26 , 27 ). In the early days, the complex characteristics of TCFA and microvessels as determined by OCT seemed to be potential predictors of subsequent progression of coronary plaque in patients with CAD ( 39 ).…”

Diagnosis of coronary layered plaque by deep learning

“…This approach is subjective and involves the risk of inter-observer variability. Indeed, inter-observer kappa values were not excellent (0.73–0.78) in previous studies 10 , 28 , 30 , 31 . Therefore, we devised the DL algorithm for the objective diagnosis of layered plaque.…”

Predictors and morphological properties of culprit healed plaques in patients with angina pectoris

“…In this study, we also observed the impact of other types of B2/C lesions, such as eccentric and calcified lesions, on the HP. One study concluded that lesions with HP had more eccentric lumens after stent implantation 26 . Another study found that calcium deposition was associated with plaque stability 27 .…”

“…One study concluded that lesions with HP had more eccentric lumens after stent implantation. 26 Another study found that calcium deposition was associated with plaque stability. 27 Our study showed that eccentric and calcified lesions were more common in patients with HP than without HP among the total study population.…”