Author + information
- Makoto Arakia,b,
- Taishi Yonetsua,b,
- Tadashi Muraia,b,
- Yoshihisa Kanajia,b,
- Eisuke Usuia,b,
- Masahiro Hoshinoa,b,
- Masahiro Hadaa,b,
- Takayuki Niidaa,b,
- Rikuta Hamayaa,b,
- Sadamitsu Ichijoa,b,
- Yoshinori Kannoa,b and
- Tsunekazu Kakutaa,b
Backgrounds: Little is known regarding the association between chronological out-stent vessel remodeling and in-stent tissue characteristics in drug-eluting stent (DES) failure. We sought to evaluate the relationship between serial vessel remodeling after DES implantation and neoatherosclerosis (NA) assessed by optical coherence tomography (OCT) in patients with DES failure.
Methods: Forty-eight patients with late and very late stent failure after DES implantation were retrospectively investigated. Inclusion criteria required IVUS examination at the time of the initial PCI and both preprocedural frequency domain OCT and IVUS examination at the time of DES failure. NA on OCT was defined as neointimal formation with the presence of lipids or calcification inside the stents. Lesions were divided into two groups with or without NA (NA; n=21, non-NA; n=27). From the serial IVUS examinations, external elastic membrane (EEM) volume and out-stent plaque volume were normalized by stent length and their changes were compared between the two groups.
Results: NA group showed longer stent age (median 5.1 years [IQR: 4.8–8.3] vs 1.4 years [0.8–4.5], P<0.01) and more prevalent sirolimus eluting stent (SES; 81.0% vs. 29.6%, P<0.01). In IVUS findings, NA group showed greater serial increase in both normalized EEM volume (VVI) and normalized out-stent plaque volume (OSPVI) (1.05 [0.41–1.90] vs. 0.11 [-0.64 – 0.80] mm2, p<0.01 and 0.88 [0.57–1.98] mm2 vs. 0.12 [-0.41 – 0.78], p<0.01). ROC curve analysis revealed that the optimal cut-off value of % OSPVI change of to predict the presence of NA was 7.1% (area under the curve, 0.76; 95% CI 0.62 – 0.87). On multivariate analysis, % change in OSPVI (OR; 1.07, 95% CI; 1.01–1.14, P=0.02) and sirolimus eluting stent (OR; 9.78, 95% CI; 2.20–43.40, P<0.01) remained as independent predictors of NA.
Conclusions: NA in late or very late DES failure was associated with out-stent positive vessel remodeling. In addition to SES, out-stent positive remodeling may help predict NA in late and very late DES failure.
Poster Hall, Hall C
Friday, March 17, 2017, 3:45 p.m.-4:30 p.m.
Session Title: Interventional Cardiology: Angiography, Intravascular Imaging and Interventional CT/MR
Abstract Category: 23. Interventional Cardiology: IVUS and Intravascular Physiology
Presentation Number: 1153-128
- 2017 American College of Cardiology Foundation