Local Determinants of Thrombus Formation Following Sirolimus-Eluting Stent Implantation Assessed by Optical Coherence Tomography

Otake, Hiromasa; Shite, Junya; Ako, Junya; Shinke, Toshiro; Tanino, Yusuke; Ogasawara, Daisuke; Sawada, Takahiro; Miyoshi, Naoki; Kato, Hiroki; Koo, Bon‐Kwon; Honda, Yasuhiro; Fitzgerald, Peter J.; Hirata, Ken Ichi

doi:10.1016/j.jcin.2009.03.003

Cited by 129 publications

(91 citation statements)

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“…Some comparisons of clinical outcomes and impacts 19,20) between 1st-DES and 2nd-DES in patients with DM have already been reported, but little has been published about angioscopic coronary lesion characteristics. Previous investigators have noted an uneven distribution of the neointima after implantation of SES or PES, 21) as well as an association between a higher residual plaque burden in reference vessel segments and edge stenosis in patients receiving SES, PES, and BMS. 22,23) The SPIRIT V diabetes study 24) showed that EES were associated with less intimal hyperplasia than PES, while the safety outcome was comparable.…”

Section: Discussionmentioning

confidence: 97%

Differences of Chronic Angioscopic Findings among Stent Types in Patients with or without Diabetes Mellitus: Sub-Analysis of a Japanese Multicenter Registry Study (MICASA)

et al. 2017

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IntroductionOur previous study multicenter study of intra-coronary angioscopy after stenting (MICASA) evaluated chronic angioscopic findings after implantation of bare metal stents (BMS) or first-generation and second-generation drug-eluting stents (1st-and 2nd-DES).1) We found more homogeneous stent coverage by white neointima and less thrombus with 2nd-DES than 1st-DES, corresponding with the better clinical outcomes in patients receiving 2nd-DES. Neointimal coverage (NC) of the stents was classified into 4 grades from 0 (none) to 3 (complete). The maximum and minimum NC grades (Max-NC and Min-NC, respectively) were assessed for each stented segment, and the heterogeneity index was calculated by subtracting Min-NC from Max-NC. The color of plaques at stented segments was classified into four grades from 0 (white) to 3 (bright yellow). Thrombus was also investigated. Results:In patients with DM, the yellow color grade was lower and the heterogeneity index was higher than in patients without DM for all stents (1.0 ± 0.8 vs. 1.2 ± 0.9, P = 0.050) and for BMS (2.0 ± 0.9 vs. 1.0 ± 0.9, P = 0.050), respectively. In addition, Min-NC was significantly higher and the plaque color grade was significantly lower in patients with DM than in those without DM for 1st-DES (Min-NC: 0.7 ± 0.6 vs. 0.4 ± 0.5, P = 0.009; color grade: 1.2 ± 0.9 vs. 1.7 ± 0.9, P = 0.006). Multivariate analysis revealed that DM was a significant negative predictor of yellow plaque (P = 0.048, OR: 0.600). Conclusions: DM had the strongest influence on the chronic characteristics of coronary lesions, especially in patients treated with 1st-generation DES.

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Section: Discussionmentioning

confidence: 97%

Differences of Chronic Angioscopic Findings among Stent Types in Patients with or without Diabetes Mellitus: Sub-Analysis of a Japanese Multicenter Registry Study (MICASA)

et al. 2017

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“…By contrast, OCT uses reflections of infrared light, provides better spatial resolution and faster data acquisition, and uses smaller diameter catheters than IVUS. OCT has high resolution (> 15 µm) and enables accurate assessment of stent strut positioning and endothelization, and determination of the histological components of coronary plaques (microcalcium deposits and macrophage accumulation) [2][3][4][5][6] . However, the low axial penetration of OCT (1.5-2 mm) fails to provide optimal visualization of the arterial wall, especially in large vessels in which the outer layers of the artery cannot be identified [7] .…”

Section: Discussionmentioning

confidence: 99%

Optical coherence tomography evaluating unstable coronary plaques: A case report

Yan

Wang

Yuan

2014

CRIM

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Unstable plaque is the main cause of ACS. However, it is difficult to find in some cases. We report a case in which conventional angiography and IVUS were unable to identify the ruptured plaque that caused the condition in a 72-year-old man. He has been suffered from accelerated angina at rest. Angiography and IVUS did not find culprit lesion. However, a ruptured thin-cap fibroatheroma plaque was found in right coronary using OCT. The symptom was disappeared after one stent coving the lesion. The case indicates that OCT is a new intravascular imaging modality that allows clear visualization of vulnerable plaques.

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“…Moreover, other studies have shown that asymmetrical expansion may be a determinant of thrombus formation after stent implantation (27).…”

Section: Eccentricity and Symmetry Indicesmentioning

confidence: 99%

“…The MUSIC trial showed that an eccentricity index ≥0.7 may positively contribute to the immediate and 6-month clinical and angiographic outcomes after PCI (25,26). Moreover, other studies have shown that asymmetrical expansion may be a determinant of thrombus formation after stent implantation (27).…”

Section: Eccentricity and Symmetry Indicesmentioning

confidence: 99%

Methods to assess bioresorbable vascular scaffold devices behaviour after implantation

et al. 2017

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Bioresorbable vascular scaffolds (BRS) represent a novel approach for coronary revascularization offering several advantages as compared to current generation DES, potentially reducing rate of late adverse events and avoiding permanent vessel caging. Nevertheless, safety concerns have been raised for an increased risk of scaffold thrombosis (ScT) in both early and late phases, probably related to a suboptimal scaffold implantation. In this context, the use of different imaging methodologies has been strongly suggested in order to guarantee an optimal implantation. We herein analyze the different imaging methodologies available to assess BRS after implantation and at follow-up. J Thorac Dis 2017;9(Suppl 9):S959-S968 jtd.amegroups.com for BRS implantation in order to confirm optimal scaffold expansion, to exclude edge dissections, struts malapposition or underexpansion. Furthermore, imaging technique may evaluate at follow-up scaffold reabsorption and vessel changes over time. Keywords: Scaffold; intravascular ultrasound (IVUS); echogenicity; virtual histology-IVUS (VH-IVUS); optical coherence tomography (OCT); multislice coronary tomography (MSCT)SubmittedWe herein analyze the different imaging methodologies available to assess BRS after implantation and at follow-up. Quantitative coronary angiography (QCA)Coronary angiography is the most important method for assessing BRS implantation. As well as for conventional stent, at least two different projections with at least 30° difference for the right coronary artery and 3 different projections with at least 30° difference for the left coronary artery must be acquired before and after BRS implantation. The treated segment and the 5 mm proximal and distal to scaffold edges should be analyzed. As the bioresorbable devices are radiolucent, the QCA analysis may be performed visualizing the metallic markers of the scaffold.The following parameters can be measured. Acute recoilIt is defined as the difference between the mean diameter of the BRS delivery balloon (or, in case of post-dilatation, mean diameter of post-dilatation balloon) at the highest pressure and the mean lumen diameter (MLD) of the stented segment after balloon deflation. It can be expressed as absolute or relative value. The acute recoil is an important parameter in relation to the success of a PCI in acute and long-time period, as it has a direct impact on minimum stent area (MSA). A MSA less than 5.0 mm 2 is associated with high probability of in-stent restenosis (6).T h e a c u t e r e c o i l o f A b s o r b B V S 1 . 1 ( A b b o t t Laboratories, Abbott park, Illinois, USA) in the Absorb Cohort B trials and DESolve Nx BRS (Elixir Medical, Sunnyvale, California, USA) were 6.7%±6.4% and 6.4%±4.6%, respectively (7,8). These values are not dissimilar to those of metallic stent, showed in a Japanese study of 154 lesions comparing the biolimus eluting stent (Nobori stent, Terumo, Tokyo, Japan), cobalt chromium everolimus eluting stent (Xience V stent, Abbott Vascular, Santa Clara, CA, USA) and pl...

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Local Determinants of Thrombus Formation Following Sirolimus-Eluting Stent Implantation Assessed by Optical Coherence Tomography

Abstract: Longer stents and greater asymmetric stent expansion may be important determinants of thrombus formation after SES implantation. In this small cohort, the presence of thrombus did not increase the risk of major adverse cardiac events.

Cited by 129 publications

References 25 publications

Differences of Chronic Angioscopic Findings among Stent Types in Patients with or without Diabetes Mellitus: Sub-Analysis of a Japanese Multicenter Registry Study (MICASA)

Differences of Chronic Angioscopic Findings among Stent Types in Patients with or without Diabetes Mellitus: Sub-Analysis of a Japanese Multicenter Registry Study (MICASA)

Optical coherence tomography evaluating unstable coronary plaques: A case report

Methods to assess bioresorbable vascular scaffold devices behaviour after implantation

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