Optical coherence tomography assessment of in-stent restenosis after percutaneous coronary intervention with two-stent technique in unprotected left main

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• 作者：Yusuke Fujino^a ; ^{yusuke.fujino1979@gmail.com" class="auth_mail" title="E-mail the corresponding author} ; Guilherme F. Attizzani^b ; Satoko Tahara^a ; Toru Naganuma^a ; Kensuke Takagi^a ; Hiroto Yabushita^a ; Wei Wang^c ; Takayuki Warisawa^a ; Yusuke Watanabe^a ; Satoru Mitomo^a ; Tomohiko Sato^a ; Naoyuki Kurita^a ; Hisaaki Ishiguro^a ; Koji Hozawa^a ; Shotaro Nakamura^a ; Hiram G. Bezerra^b ; Sunao Nakamura^a
• 关键词：DES ; drug-eluting stents ; EF ; ejection fraction ; FD ; flow divider ; GEE ; generalized estimating equations ; ISR ; in-stent restenosis ; LW ; lateral wall ; LAD ; left anterior descending artery ; LCX ; left circumflex artery ; MACE ; major adverse cardiac events ; MLA ; minimum lumen area ; MSA ; minimum stent area ; NIH ; neointimal hyperplasia ; OCT ; optical coherence tomography ; PCI ; percutaneous coronary intervention ; QCA ; quantitative coronary angiography ; ROI ; region of interest ; SIT ; strut-level intimal th
• 刊名：International Journal of Cardiology
• 出版年：2016
• 出版时间：15 September 2016
• 年：2016
• 卷：219
• 期：Complete
• 页码：285-292
• 全文大小：1347 K

文摘

Optical coherence tomography (OCT) has contributed to a better understanding of in-stent restenosis (ISR); however, studies evaluating ISR pattern after two-stent technique in unprotected left main (ULM) are lacking. We aim to evaluate the ISR pattern of proximal LAD and LCX after two-stent technique in ULM.

Methods

We performed OCT in 26 patients with isolated or combined ISR (identified by angiography as > 50%) after two stent implantation in the proximal LCX and LAD. Finally, 13 LAD and 22 LCX ISR lesions underwent OCT assessments. OCT analyses were undertaken in the proximal segments of the LAD and LCX. In addition, we compared OCT findings in the flow divider (FD) and lateral wall (LW).

Results

In both the LAD and LCX, the distance from the ostium to the minimum lumen area (MLA; LAD, 2.00 mm [1.00, 3.00]; LCX, 1.00 mm [0.00, 1.80] distal to ostium) was short. Uncovered struts were more common on the FD side compared with the LW in the LAD (6.25% [0.00, 20.00] vs 0.00% [0.00, 0.00], respectively, p = 0.016) and LCX (11.32% [0.00, 19.44] vs 0.00% [0.00, 4.55], respectively, p < 0.001). Conversely, neointimal hyperplasia (NIH) was significantly thicker on the FD side compared with the LW in the LCX (0.31 mm [0.19, 0.47] vs 0.15 mm [0.09, 0.31], p < 0.001).

Conclusions

While uncovered struts were more commonly found on the FD side of both arteries, NIH was significantly thicker on the FD side compared with the LW in the LCX. These unique findings might indicate inferior outcomes after two-stent techniques in ULM bifurcation lesions.