Thin-cap fibroatheroma and large calcification at the proximal stent edge correlate with a high proportion of uncovered stent struts in the chronic phase

Ueda, Tomoya; Uemura, Shiro; Watanabe, Makoto; Dote, Yoko; Goryo, Yutaka; Yu, Simon C.H.; Soeda, Tsunenari; Okayama, Satoshi; Kawata, Hiroyuki; Kawakami, Rika; Okura, Hiroyuki; Saito, Yoshihiko

doi:10.1097/mca.0000000000000380

Cited by 12 publications

(8 citation statements)

References 33 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…The effect of underlying plaque on stent strut coverage has not been well characterized. Some previous studies reported that neointima or stent strut coverage was less on a thin‐cap fibroatheroma 25,26 . In contrast, a recent OCT study demonstrated that percent covered struts and percent neointima were significantly greater and thicker on a lipidic plaque 27 .…”

Section: Discussionmentioning

confidence: 94%

“…Some previous studies reported that neointima or stent strut coverage was less on a thin‐cap fibroatheroma. 25 , 26 In contrast, a recent OCT study demonstrated that percent covered struts and percent neointima were significantly greater and thicker on a lipidic plaque. 27 In the present study, we compared lipid versus non‐lipid segments within the same lesions in the same patients because this allowed each patient to serve as his or her own control; and we observed more NIH and better stent strut coverage in a lipidic segment compared with a nonlipidic segment without difference of MLA at 6‐month follow‐up.…”

Section: Discussionmentioning

confidence: 95%

See 1 more Smart Citation

Comparison of 6‐month vascular healing response after bioresorbable polymer versus durable polymer drug‐eluting stent implantation in patients with acute coronary syndromes: A randomized serial optical coherence tomography study

Noguchi

Dohi

Okazaki

et al. 2021

Cathet Cardio Intervent

View full text Add to dashboard Cite

Objectives This study was conducted to use optical coherence tomography (OCT) to compare vascular healing between bioresorbable polymer (BP) and durable polymer (DP) everolimus‐eluting stents (EES) in patients with acute coronary syndromes (ACS). Background Whether BP‐EES induce better vascular healing compared to contemporary DP‐EES remains controversial, especially for ACS. Methods In this prospective, randomized, non‐inferiority trial, we used OCT to compare 6‐month vascular healing in patients with ACS randomized to BP versus DP‐EES: percent strut coverage (primary endpoint, non‐inferiority margin of 2.0%) and neointimal thickness and percent neointimal hyperplasia (NIH) volume. As an exploratory analysis, morphological factors related to the endpoints and the effect of underlying lipidic plaque on stent healing were evaluated. Results A total of 104 patients with ACS were randomly assigned to BP‐EES (n = 52) versus DP‐EES (n = 52). Of these, 86 patients (40 BP‐EES and 46 DP‐EES) were included in the final OCT analyses. Six‐month percent strut coverage of BP‐EES (83.6 ± 11.4%) was not non‐inferior compared to those of DP‐EES (81.6 ± 13.9%), difference 2.0% (lower 95% confidence interval‐2.6%), pnon‐inferiority = 0.07. There were no differences in neointimal thickness 70.0 ± 33.9 μm versus 67.2 ± 33.9 μm, p = 0.71; and percent NIH volume 7.5 ± 4.7% versus 7.3 ± 5.3%, p = 0.85. By multivariable linear regression analysis, stent type was not associated with percent strut coverage or percent NIH volume; however, percent baseline embedded struts or stent expansion was positively associated with percent NIH volume. Greater NIH volume was observed in lipidic compared with non‐lipidic segments (8.7 ± 5.6% vs. 6.1 ± 5.2%, p = 0.005). Conclusions Six‐month strut coverage of BP‐EES was not non‐inferior compared to those of DP‐EES in ACS patients. Good stent apposition and expansion were independently associated with better vascular healing.

show abstract

Section: Discussionmentioning

confidence: 94%

Section: Discussionmentioning

confidence: 95%

Comparison of 6‐month vascular healing response after bioresorbable polymer versus durable polymer drug‐eluting stent implantation in patients with acute coronary syndromes: A randomized serial optical coherence tomography study

Noguchi

Dohi

Okazaki

et al. 2021

Cathet Cardio Intervent

View full text Add to dashboard Cite

show abstract

“…Specifically, the main features of vulnerable plaques were TCFA and a large lipid pool [ 18 ], which could influence post-stent outcomes, as reported by a clinical study [ 19 ]. Ueda et al [ 20 ] identified that lipid-rich plaques underlying stent edges were strong predictors of uncovered stent struts and that TCFA and large calcification at the proximal stent edge were strong predictors of uncovered stent struts at follow-up. In post-PCI OCT assessing 1002 lesions, suboptimal stent deployment, including in-stent minimal lumen area, distal reference lumen area, and dissection at the distal stent edge, was associated with an increased incidence of MACEs, which are a composite of all-cause death, MI, and target lesion revascularization during follow-up [ 21 ].…”

Section: Discussionmentioning

confidence: 99%

Prognostic value of characteristics of plaque combined with residual syntax score among patients with STEMI undergoing primary PCI: an intravascular optical coherence tomography study

et al. 2021

View full text Add to dashboard Cite

Aim The present study aimed to explore these characteristics, particularly thin-cap fibroatheroma (TCFA), in relation to residual syntax score (rSS) in patients who presented with acute MI. Methods and outcomes A total of 434 consecutive patients with MI aged ≥18 years who had STEMI underwent primary PCI. Notably, compared with other subgroups, the presence of TCFA in culprit lesions and a higher level of rSS, were significantly associated with MACE. When rSS was divided into three groups, high rSS levels were associated with a higher incidence of MACE, in the subgroups of without TCFA (P = 0.005), plaque erosion (P = 0.045), macrophage infiltration (P = 0.026), and calcification (P = 0.002). AUC of ROC curve was 0.794 and 0.816, whereas the AUC of the survival ROC was 0.798 and 0.846. Conclusion The results of this study could be used in clinical practice to support risk stratification. Trial registration This study was registered at ClinicalTrials.gov as NCT03593928.

show abstract

“…After intracoronary administration of 1 mg of isosorbide dinitrate, pull‐back was performed during continuous injection of X‐ray contrast media or lactated low‐molecular‐weight dextran at 2.5–3.5 mL/s through the guiding catheter using an injection pump to remove blood from the field of view and to allow for clear visualization of the vessel wall. Images were acquired at 5 frames/mm and an automated pull‐back speed of 20 mm/s …”

Section: Methodsmentioning

confidence: 99%

Usefulness of longitudinal reconstructed optical coherence tomography images for predicting the need for the reverse wire technique during coronary bifurcation interventions

Watanabe

Okura

Okamura

et al. 2018

Cathet Cardio Intervent

Self Cite

View full text Add to dashboard Cite

Objectives The aim is to investigate the usefulness of longitudinal reconstructed optical coherence tomography (OCT) images in selecting the reverse wire (RW) technique for inserting a guidewire into a side branch (SB). Background It is sometimes necessary to protect the SB with a guidewire to prevent SB complications in PCI for bifurcation lesions. The RW is a novel method for guidewire insertion into an extremely angulated SB when the standard antegrade wire (AW) approach is difficult. Methods This retrospective study included 46 consecutive patients who underwent OCT‐guided PCI in bifurcation lesions with significant SB stenosis. Patients were divided into two groups: 36 patients with successful guidewire crossing using the AW (AW group) and 10 patients with unsuccessful AW but successful RW guidewire crossing (RW group). SB angle and branch point (BP) slope, defined as the angle between the line connecting the proximal and distal BPs and the vertical, were measured using longitudinal reconstructed OCT images. Results The RW group had a significantly larger SB angle and higher BP slope than the AW group (108.7 ± 11.4° vs. 76.2 ± 14.9°; P < 0.0001, 128.7 ± 31.6° vs. 82.9 ± 33.6°; P = 0.0004, respectively). Receiver operating characteristic curve analysis indicated that SB angle ≥ 100° and BP slope ≥ 120° are optimal cutoff values for predicting the need for RW (area under the curve 0.97, sensitivity 90.0%, specificity 91.7%; area under the curve 0.83, sensitivity 80.0%, specificity 86.1%, respectively). Conclusions Longitudinal reconstructed OCT is useful for selecting the wiring technique for bifurcation lesions.

show abstract

Thin-cap fibroatheroma and large calcification at the proximal stent edge correlate with a high proportion of uncovered stent struts in the chronic phase

Abstract: TCFA and large calcification at the proximal stent edge are strong predictors of uncovered stent struts. OCT is useful for selecting stent landing sites in terms of future occurrence of uncovered stent struts.

Cited by 12 publications

References 33 publications

Comparison of 6‐month vascular healing response after bioresorbable polymer versus durable polymer drug‐eluting stent implantation in patients with acute coronary syndromes: A randomized serial optical coherence tomography study

Comparison of 6‐month vascular healing response after bioresorbable polymer versus durable polymer drug‐eluting stent implantation in patients with acute coronary syndromes: A randomized serial optical coherence tomography study

Prognostic value of characteristics of plaque combined with residual syntax score among patients with STEMI undergoing primary PCI: an intravascular optical coherence tomography study

Usefulness of longitudinal reconstructed optical coherence tomography images for predicting the need for the reverse wire technique during coronary bifurcation interventions

Contact Info

Product

Resources

About