- Email: [email protected]
AS-090 Comparison of Endothelial Coverage and Stent Malapposition between Infarct-Related and Non-Infarct Coronary Lesions Treated with Everolimus-Eluting Stents; Optical Coherence Tomography Analysis
April 24 –27, 2012
O R A L A B S T R A C T S
(SES: n⫽18, PES: n⫽4, ZES: n⫽3). All of them were treated only with balloon angioplasty and received OCT examination before and after the balloon angioplasty. We measured neointimal volume and analyzed neointimal intensity (divided 1 to 256 levels) of DES restenotic lesions with OCT images. We studied the correlation between the % ⫺reduction of DES restenotic neointima volume during the balloon angioplasty and the neointimal intensity of the pre balloon dilatation. Study population was divided into two groups according to the median of the pre dilatation neointimal intensity: lower neointimal tissue group and higher neointimal tissue group. We observed the changes of neointimal intensity during the balloon angioplasty in each group and compared the frequency of recurrent TLR after the balloon angioplasty between the two groups. Results: The average time from stent implantation was 16 months. %⫺reduction of neointimal volume was correlated with neointimal intensity of the pre balloon dilatation (y⫽⫺0.98x ⫹111, R2⫽0.57). In the high intensity group, there were no significant changes of intensity before and after the balloon angioplasty (pre vs. post; 78vs. 82, p⫽0.12), while in the low intensity group, there were significant changes of intensity before and after the balloon angioplasty (pre vs. post; 56vs. 77, p⬍0.0001). This result means that in DES restenotic lesions, low intensity neointima more easily disappeared and scattered into distal coronary and obtained the bigger luminal area compared to high intensity neointima. And recurrent TLR at 6-month after the balloon angioplasty was significantly lower in lower intensity group compared to higher intensity group (8% vs. 42%, p⬍0.0001, respectively). Conclusion: OCT guided PCI is useful to decide treatment strategy for DES restenosis lesions.
AS-090 Comparison of Endothelial Coverage and Stent Malapposition between Infarct-Related and Non-Infarct Coronary Lesions Treated with Everolimus-Eluting Stents; Optical Coherence Tomography Analysis. Sung Gyun Ahn. Wonju Christian Hospital, Wonju, Korea (Republic of). Background: To compare using optical coherence tomography (OCT) mid-tem vascular response between acute myocardial infarction (AMI) and non-AMI settings after everolimus-eluting stent (EES) implantation. Methods: The present study was conducted as a cross-sectional observational study using a prospective OCT registry. A total of 48 coronary lesions (12 AMI, 36 non-AMI) were evaluated by OCT at 12 months after EES implantation. The percentage of neointimal hyperplasia (NIH) area at every 1-mm cross section was measured. The degree of neointimal coverage and the prevalence of malapposition were compared between infarct-related and non-infarct coronary lesions. Results: The percentage of NIH and prevalence of uncovered strut were similar in both groups. The prevalence of malapposition and of malapposition with uncovered strut were significantly higher in infarctrelated lesions than non-infarct coronary lesions (2.1 ⫾ 3.1 vs. 0.5 ⫾ 1.2, P⫽0.038 and 0.9 ⫾ 1.6 vs. 0.05 ⫾ 0.2, P⫽0.02)
Difference in the rate of malapposition and of uncovered stent strut with malapposition on OCT
46S
Conclusion: Neoinitimal coverage occurred similarly in infarctrelated and non-infarct coronary lesions. However stent malapposition developed more often in infarct-related lesions than in non-infarct coronary lesions.
AS-091 Intravascular Ultrasound Optimization of Stent Area in Patients with Unprotected Left Main Disease. Won-Jang Kim1, Soo-Jin Kang1, Jong-Young Lee1, Duk-Woo Park1, Sung-Cheol Yun2, Seung-Whan Lee1, Young-Hak Kim1, Choel-Whan Lee1, Seong-Wook Park1, Seung-Jung Park1. 1Department of Cardiology, University of Ulsan College of Medicine Asan Medical Center, Seoul, Korea (Republic of); 2Department of Biostatistics, University of Ulsan College of Medicine Asan Medical Center, Seoul, Korea (Republic of). Background: Using intravascular ultrasound (IVUS), we assessed the optimal stent area to prevent angiographic in-stent restenosis (ISR) after Sirolimus-eluting stent implantation for unprotected left main coronary artery (LM) disease. Methods: A total of 403 patients (403 LM lesions) treated with single- or two-stent strategies (crushing and T-stent) had immediate post-stenting IVUS and 9-month follow-up angiography. Ostial left anterior descending artery ([LAD], 5mm distal to carina), polygon of confluence (POC, confluence zone of LAD and left circumflex artery [LCX]) and proximal LM segment above the POC were evaluated. LCX-pullback was performed in 104 of 114 lesions with two-stent and ostial LCX (5mm distal to carina) was assessed. Post-stenting minimal stent area (MSA) was measured in each segment. Results: In the overall, 46 (11.4%) showed angiographic restenosis at 9 months. Restenosis was identified in 3 (4.5%) of 67 non-bifurcation lesions with single-stent, 14 (6.3%) of 222 bifurcation lesions with single-stent cross-over, and 29 (25.4%) of 114 bifurcation lesions with two-stent. To predict ISR of the corresponding in-stent segment, the best cut-off of MSA was 6.3mm2 within the LAD ostium, 7.2mm2 within the POC, and 8.2mm2 within the proximal LM above the POC. In 104 lesions treated with two-stent technique, ISR of the LCX ostium was predicted by the MSA within the LCX ostium ⬍5.0mm2. Using those criteria, 133 (33.8%) revealed underexpansion of at least one stented segment. Angiographic ISR (at any stented segments) was more frequent in the lesions with underexpansion vs. those without (24.1% vs. 5.4%, p⬍0.001). Two-year MACE-free survival rate was significantly lower in the patients with underexpansion vs. those without (89⫾3% vs. 98⫾1%, log-rank p⬍0.001). Using the multivariable Cox model, post-stenting underexpansion was an independent predictor for MACE (adjusted HR⫽5.56, 95% CI⫽1.99 –15.49, p⫽0.001).
The American Journal of Cardiology姞 APRIL 24 –27, 2012 ANGIOPLASTY SUMMIT ABSTRACTS/Oral
O R A L A B S T R A C T S
(SES: n⫽18, PES: n⫽4, ZES: n⫽3). All of them were treated only with balloon angioplasty and received OCT examination before and after the balloon angioplasty. We measured neointimal volume and analyzed neointimal intensity (divided 1 to 256 levels) of DES restenotic lesions with OCT images. We studied the correlation between the % ⫺reduction of DES restenotic neointima volume during the balloon angioplasty and the neointimal intensity of the pre balloon dilatation. Study population was divided into two groups according to the median of the pre dilatation neointimal intensity: lower neointimal tissue group and higher neointimal tissue group. We observed the changes of neointimal intensity during the balloon angioplasty in each group and compared the frequency of recurrent TLR after the balloon angioplasty between the two groups. Results: The average time from stent implantation was 16 months. %⫺reduction of neointimal volume was correlated with neointimal intensity of the pre balloon dilatation (y⫽⫺0.98x ⫹111, R2⫽0.57). In the high intensity group, there were no significant changes of intensity before and after the balloon angioplasty (pre vs. post; 78vs. 82, p⫽0.12), while in the low intensity group, there were significant changes of intensity before and after the balloon angioplasty (pre vs. post; 56vs. 77, p⬍0.0001). This result means that in DES restenotic lesions, low intensity neointima more easily disappeared and scattered into distal coronary and obtained the bigger luminal area compared to high intensity neointima. And recurrent TLR at 6-month after the balloon angioplasty was significantly lower in lower intensity group compared to higher intensity group (8% vs. 42%, p⬍0.0001, respectively). Conclusion: OCT guided PCI is useful to decide treatment strategy for DES restenosis lesions.
AS-090 Comparison of Endothelial Coverage and Stent Malapposition between Infarct-Related and Non-Infarct Coronary Lesions Treated with Everolimus-Eluting Stents; Optical Coherence Tomography Analysis. Sung Gyun Ahn. Wonju Christian Hospital, Wonju, Korea (Republic of). Background: To compare using optical coherence tomography (OCT) mid-tem vascular response between acute myocardial infarction (AMI) and non-AMI settings after everolimus-eluting stent (EES) implantation. Methods: The present study was conducted as a cross-sectional observational study using a prospective OCT registry. A total of 48 coronary lesions (12 AMI, 36 non-AMI) were evaluated by OCT at 12 months after EES implantation. The percentage of neointimal hyperplasia (NIH) area at every 1-mm cross section was measured. The degree of neointimal coverage and the prevalence of malapposition were compared between infarct-related and non-infarct coronary lesions. Results: The percentage of NIH and prevalence of uncovered strut were similar in both groups. The prevalence of malapposition and of malapposition with uncovered strut were significantly higher in infarctrelated lesions than non-infarct coronary lesions (2.1 ⫾ 3.1 vs. 0.5 ⫾ 1.2, P⫽0.038 and 0.9 ⫾ 1.6 vs. 0.05 ⫾ 0.2, P⫽0.02)
Difference in the rate of malapposition and of uncovered stent strut with malapposition on OCT
46S
Conclusion: Neoinitimal coverage occurred similarly in infarctrelated and non-infarct coronary lesions. However stent malapposition developed more often in infarct-related lesions than in non-infarct coronary lesions.
AS-091 Intravascular Ultrasound Optimization of Stent Area in Patients with Unprotected Left Main Disease. Won-Jang Kim1, Soo-Jin Kang1, Jong-Young Lee1, Duk-Woo Park1, Sung-Cheol Yun2, Seung-Whan Lee1, Young-Hak Kim1, Choel-Whan Lee1, Seong-Wook Park1, Seung-Jung Park1. 1Department of Cardiology, University of Ulsan College of Medicine Asan Medical Center, Seoul, Korea (Republic of); 2Department of Biostatistics, University of Ulsan College of Medicine Asan Medical Center, Seoul, Korea (Republic of). Background: Using intravascular ultrasound (IVUS), we assessed the optimal stent area to prevent angiographic in-stent restenosis (ISR) after Sirolimus-eluting stent implantation for unprotected left main coronary artery (LM) disease. Methods: A total of 403 patients (403 LM lesions) treated with single- or two-stent strategies (crushing and T-stent) had immediate post-stenting IVUS and 9-month follow-up angiography. Ostial left anterior descending artery ([LAD], 5mm distal to carina), polygon of confluence (POC, confluence zone of LAD and left circumflex artery [LCX]) and proximal LM segment above the POC were evaluated. LCX-pullback was performed in 104 of 114 lesions with two-stent and ostial LCX (5mm distal to carina) was assessed. Post-stenting minimal stent area (MSA) was measured in each segment. Results: In the overall, 46 (11.4%) showed angiographic restenosis at 9 months. Restenosis was identified in 3 (4.5%) of 67 non-bifurcation lesions with single-stent, 14 (6.3%) of 222 bifurcation lesions with single-stent cross-over, and 29 (25.4%) of 114 bifurcation lesions with two-stent. To predict ISR of the corresponding in-stent segment, the best cut-off of MSA was 6.3mm2 within the LAD ostium, 7.2mm2 within the POC, and 8.2mm2 within the proximal LM above the POC. In 104 lesions treated with two-stent technique, ISR of the LCX ostium was predicted by the MSA within the LCX ostium ⬍5.0mm2. Using those criteria, 133 (33.8%) revealed underexpansion of at least one stented segment. Angiographic ISR (at any stented segments) was more frequent in the lesions with underexpansion vs. those without (24.1% vs. 5.4%, p⬍0.001). Two-year MACE-free survival rate was significantly lower in the patients with underexpansion vs. those without (89⫾3% vs. 98⫾1%, log-rank p⬍0.001). Using the multivariable Cox model, post-stenting underexpansion was an independent predictor for MACE (adjusted HR⫽5.56, 95% CI⫽1.99 –15.49, p⫽0.001).
The American Journal of Cardiology姞 APRIL 24 –27, 2012 ANGIOPLASTY SUMMIT ABSTRACTS/Oral