AS-176: Comparison of Clinical and Angiographic Outcomes of Overlapping Sirolimus-Eluting Stents and 38-mm Paclitaxel-Eluting Stents in Diffuse Long Coronary Lesions

Wednesday, April 22 - Friday, April 24, 2009 (E-Poster Abstract Zone) Methods: This study consisted of 32 SFs in 19 patients who received a second follow-up coronary angiography after detection of an SES fracture. SFs in patients who had received balloon angioplasty or additional stent insertion at the time of SF detection were excluded. We compared the SF site with the smallest non-SF site where each lumen diameter was the smallest in a second follow-up angiography. Results: Mean follow-up period from first to second angiography was 422 ⫾ 158 days. In-stent restenosis (ISR) was found in 11 (34.4%) SFs at first angiography, and 3 newly developed ISR (n ⫽ 14, 43.7%) were seen at second angiography. At first angiography, SF site and smallest non-SF site late loss were 0.52 ⫾ 0.53 mm and 0.35 ⫾ 0.22 mm (p ⫽ 0.039). Smallest non-SF sites at second angiography were not the same as those at first angiography. SF site late loss was also significantly higher than that of the smallest non-SF site (0.51 ⫾ 0.53 mm vs 0.20 ⫾ 0.21 mm; p ⫽ 0.004) at second angiography. Conclusion: Neointimal hyperplasia caused by SF through local mechanical irritation and inflammation may be another cause of latedeveloping restenosis after SES implantation.

AS-174 Ischemia-Driven Late Target Lesion Revascularization Due to “Catch-Up” Phenomenon after Implantation of Drug-Eluting Stents. Hun-Jun Park1, Ki-Bae Seung1, Pum-Joon Kim1, Chan-Seok Park2, Jung-Sun Kim3, Yang-Su Jang3, Jae-Hyung Kim4, Kyu-Bo Choi1. 1Kangnam St. Mary’s Hospital, Seoul, Republic of Korea; 2Holy Family Hospital, Gyeong gi-do, Republic of Korea; 3 Severance Hospital, Seoul, Republic of Korea; 4St. Paul’s Hospital, Seoul, Republic of Korea.

EP O S T E R A B S T R A C T S

Background: Concerns have been raised about the long-term efficacy and safety of drug-eluting stents (DES). We postulated that suppression of neointimal hyperplasia by DES may be temporary and that a “late catch-up” (LCU) phenomenon in restenosis may observed. We sought to describe several cases of ischemia-driven late target lesion revascularization (TLR) after implantation of DES due to LCU and examined their clinical and angiographic characteristics. Methods: From October 2003 to May 2006, we retrospectively reviewed coronary angiograms (CAG) and collected data on LCU cases after implantation of DES from 2 cardiovascular centers. LCU was defined as 1) no significant restenosis on routine follow-up CAG after implantation of DES, 2) newly developed ischemic symptoms and/or evidence of myocardial ischemia on stress tests (treadmill or thallium perfusion scan) beyond the first 6 to 9 months after routine follow-up CAG, and 3) significant restenosis in the previously stented target lesion on ischemia-driven follow-up CAG. Results: Eighteen segments of LCU were detected in 18 patients (12 men; mean age 58.8 ⫾ 13.2 years). Mean follow-up duration of LCU was 24.9 ⫾ 11.5 months. Seventeen (94.4%) were sirolimuseluting stents (SES) and 1 (5.6%) was a paclitaxel-eluting stent (PES). Eleven of eighteen (61.1%) LCU segments were located in left anterior descending artery, followed by right coronary (16.7%), left circumflex (11.1%), and ramus intermedius artery (11.1%). Regarding patterns of neointimal growth, 11/18 (61.1%) were focal restenosis, and 9/11 (81.8%) were stent-marginal restenosis. On quantitative coronary analysis, late loss and percent diameter stenosis (%DS) at ischemia-driven follow-up CAG was significantly higher than those at routine follow-up CAG (late loss: 0.30 vs 2.02 mm, p ⬍0.001; %DS: 18.1% vs 3.2%, p ⬍0.001). Conclusion: LCU phenomenon may be a considerable late complication after DES implantation, especially with SES.

AS-175 Predictive Factors of Procedural Success for Percutaneous Coronary Intervention of Chronic Total Occlusion: Lesion and Procedural Characteristics. Jae Hong Park1, Hee-Yeol Kim2, Hun-Jun Park1, Yun-Seok Choi3, Wook-Sung Chung3, Doo-Soo Jeon4, Keon-Woong Moon5, Jong-Min Lee6, Sung-Ho Her6, Ki-Dong Yoo5, Dong-Bin Kim7, Mahn-Won Park1, Ju-Yeol Baek1, Sang-Hyun Ihm2, Chan-Seok Park2, Ki-Bae Seung1, Jae-Hyung Kim7, Kyu-Bo Choi1. 1Kang-Nam St. Mary’s Hospital, Seoul, Republic of Korea; 2Holy Family Hospital, Kyeonggi-do, Republic of Korea; 3St. Mary’s Hospital, Seoul, Republic of Korea; 4 Incheon St. Mary’s Hospital, Incheon, Republic of Korea; 5St. Vincent’s Hospital, Kyeonggi-do, Republic of Korea; 6Daejeon St. Mary’s Hospital, Daejeon, Republic of Korea; 7St. Paul’s Hospital, Seoul, Republic of Korea. Background: There are limited data the procedural success rates and their predictive factors in percutaneous coronary intervention (PCI) for chronic total occlusion (CTO). This study was designed to identify predictive factors of procedural success with regard to lesion and procedural characteristics. Methods: Between January 2006 and June 2008, 171 consecutive patients underwent PCI for the CTO at Catholic university hospitals in Korea. These patients were analyzed in terms of lesion and procedural characteristics, success rate, predictors of procedural success, and clinical outcome. The study population was grouped by procedural success and failure. In-hospital and long-term clinical outcomes were compared in each group. Results: The procedural success rate was 80.7%. The wiring method of penetrating CTO was via the antegrade approach except for in 2 patients. Multivariate regression analysis showed that the success rate was significantly influenced by the following variables: extent of the coronary artery disease (p ⫽ 0.05), morphology of occlusion (p ⫽ 0.005), calcification of the lesion (p ⬍0.0001), and bridging collaterals (p ⫽ 0.012). Other factors were B-type natriuretic peptide (BNP) and pro-BNP (p ⬍0.0001). Total major cardiac adverse events (MACE) was 29 (1 in-hospital death, 6 target lesion revascularizations, 11 target lesion revascularizations, 3 stent thromboses, 8 congestive heart failures). There was no difference in clinical success (outcome) between the success group and the failure group: n ⫽ 24 (15.6%) vs n ⫽ 5 (9.1%), respectively (p ⫽ 0.418). Conclusion: In this study, a relatively high success rate of PCI for CTO was achieved. Predictive factors of successful PCI for CTO were lesser vessel extent, tapered pattern of occlusion, no lesion calcification, no bridging collaterals, and low levels of BNP and pro-BNP.

AS-176 Comparison of Clinical and Angiographic Outcomes of Overlapping Sirolimus-Eluting Stents and 38-mm PaclitaxelEluting Stents in Diffuse Long Coronary Lesions. Ju Yeol Baek, Ki-Bae Seung, Seong-Gyu Yoon, Bum-Joon Kim, Mahn-Won Park, Yoon-Seok Koh, Hae-Yuk Jung, Sang-Hong Baek, Seung-Won Gin, Jae-Hyung Kim, Kyu-Bo Choi. Kangnam St. Mary’s Hospital, Seoul, Republic of Korea. Background: Overlapping sirolimus- (SES) or paclitaxel- (PES) eluting stent implantation for diffuse long coronary lesions has proved to be effective. However, the safety and effectiveness of 38-mm PES has not been proved compared with SES. We sought to examine the clinical and angiographic outcomes of overlapping SES compared with 38-mm PES in diffuse long coronary lesions. Methods: Sixty patients who received drug-eluting stents for the treatment of the diffuse long lesions were identified, 30 of whom

76B The American Journal of Cardiology姞 APRIL 22–24 2009 ANGIOPLASTY SUMMIT ABSTRACTS/E-Poster

Wednesday, April 22 - Friday, April 24, 2009 (E-Poster Abstract Zone) received 38-mm PES and 30 overlapping SES. Baseline clinical and angiographic characteristics were balanced. Results: At 6-month follow-up, angiographic examination was performed in all patients. There was no difference between the 2 groups in late loss area of neointimal hyperplasia (p ⫽ 0.154; mean late loss SES ⫽ 0.5550, PES ⫽ 0.214). However, there was some higher late loss at the overlapping site in the SES group (26%, 8/30 patients). Major adverse cardiac events were similar in patients treated with SES compared with those treated with 38-mm PES. Conclusion: Compared with using overlapping SES in diffuse long lesions, percutaneous coronary intervention with 38-mm PES exhibited similar late loss area and clinical outcomes. However, overlapping sites in the SES group may be a source of higher rates of intimal hyperplasia in diffuse long lesions.

AS-177 Long-Term Outcome following Drug-Eluting Stent Implantation for Restenosis Lesions. Makoto Utsunomiya. Kyoto Katsura Hospital, Kyoto, Japan. Background: Very late stent thrombosis is a concern with drug-eluting stents (DES). However, using DES in restenosis lesions at high risk for secondary restenosis is essential. The aim of this study was to evaluate outcomes for DES implantation for restenotic lesions. Methods: Between August 2004 and January 2008, we investigated 216 consecutive restenotic lesions in 189 patients treated with DES (sirolimus-eluting stent [SES] ⫽ 201 lesions; paclitaxel-eluting stent [PES] ⫽ 15 lesions). Of these, 134 lesions were in-stent restenosis lesions and 35 were DES restenosis lesions. Results: Clinical follow-up rate was 96.8%, and mean follow-up length was 27.4 months. There were 5 (2.4%) deaths, 4 patients with noncardiac death and 1 with sudden death. Thirty-two patients (15.3%) received repeat target lesion revascularization (TLR). Eight-month follow-up angiography was performed for 192 lesions (88.9%). Qualitative comparative analysis (QCA) revealed mean late loss of 0.37 mm; furthermore, 22 lesions (11.5%) demonstrated restenosis, which was defined as %diameter stenosis ⬍50%. There were no significant differences in TLR, late loss, and restenosis rates between deployed stents in cases of SES and PES usage. There were no significant differences between in-stent restenosis. Conclusion: Treatment of restenosis lesion with DES is feasible with a relatively low restenosis rate of 11.5%.

AS-178 Transradial Rotational Atherectomy with Drug-Eluting Stents for Heavily Calcified Lesions. Cheng Xing Shen, Gen Shan Ma, Yi Feng, Qiming Dai, Zhong Chen, Dan Luo, Jian Dong Ding, Cheng Chun Tang, Run Ming Wang, Huiping Wang. Zhongda Hospital, Southeast University, Nanjing, China. Background: Calcified lesions are always a treatment challenge, and periprocedural complications with a transfemoral approach are higher compared with a transradial approach. The objective of this study was to assess the immediate and 1-year outcomes of the combination of rotational atherectomy (RA) with drug-eluting stents (DES) via a transradial approach for heavily calcified lesions. Methods: Twenty-three patients with severely calcified lesions were treated with a transradial with RA followed by percutaneous coronary intervention (PCI) with DES implantation. The procedural and 1-year follow-up success rates were analyzed. Results: RA was carried out successfully in all cases with successful subsequent DES deployment. Twenty-one cases were performed by 6-Fr guiding, 2 by 7-Fr guiding. The burrs passed through the lesions successfully in all cases. Seventeen cases were treated with 1.25-mm

burr and 6 cases with 2 burrs. All patients received percutaneous transluminal coronary angioplasty after RA, and stents were deployed successfully. There was no evidence of pericardial effusion in any patient. One patient had severe coronary spasm, and 2 showed slow flow during the procedure. Eleven patents had troponin I elevation greater than threefold, but only 1 patient experienced a greater than twofold rise in creatine kinase-MB. No patient required emergency bypass graft surgery, and there was no in-hospital mortality. There was no major bleeding after the procedure. One-year follow-up showed good clinical results, and 1 in-stent restenosis was seen in follow-up angiogram in 13 patients. Conclusion: Transradial RA plus DES can increase the procedural success rate for heavily calcified lesions and can be carried out safely with good in-hospital and 1-year results.

AS-179 Long-Term Clinical Outcomes in Diabetic Patients with Long Chronic Total Occlusion Treated with Drug-Eluting Stents. Han Jun Pei, Yong Jian Wu, Guang Yuan Song, Yue Jin Yang. FuWai Hospital, Beijing, China. Background: There are few data about the safety and efficacy of successful recanalization of long chronic total occlusion (CTO) lesions in diabetic patients. Diabetes, CTO, and long lesions are all the risk factors for unfavorable outcomes after percutaneous coronary intervention (PCI). The aim of this study was to assess clinical outcomes of long CTO treated with drug-eluting stents (DES) in patients with diabetes mellitus. Methods: From January 2006 to May 2007, 143 consecutive patients who had a sirolimus- or paclitaxel-eluting stent implanted for CTO were divided into 2 groups according to total stent length, then compared for clinical outcome. Death, myocardial infarction, repeat angioplasty, and coronary artery bypass were considered adverse events in 139 patients with available long-term follow-up (19.8 ⫾ 5.1 months). Results: There were no differences between groups in baseline clinical and main angiographic characteristics. There were 6 (8.6%) and 9 (12.3%) events in the CTO-1 group (total stent length ⬍40 mm) and the CTO-2 group (total stent length ⱖ40 mm), respectively (p ⫽ ns). In univariate analysis, %residual lesion and final minimal luminal diameter (MLD) were found to be significantly related to events at long-term follow-up. Cox regression analysis identified final MLD (odds ratio 0.097, 95% confidence interval 0.013– 0.694, p ⫽ 0.02) as the only dependant predictor at long-term follow-up. Conclusion: Patients in the 2 groups did not differ at long-term follow-up in terms of death, myocardial infarction, and target lesion revascularizations. Final MLD is a significant predictor of events during long-term follow-up.

AS-180 Serial Follow-Up of Coronary Artery Aneurysm after DrugEluting Stent Implantation at 6 Months and 2 Years. Won-Jang Kim, Young-Hak Kim, Jong-Young Lee, Duk-Woo Park, Seung-Whan Lee, Sung-Cheol Lee, Cheol Whan Lee, Myeong-Ki Hong, Seong-Wook Park, Seung-Jung Park. Asan Medical Center, Seoul, Republic of Korea. Background: There are limited data on long-term incidence and clinical outcomes of coronary artery aneurysm (CAA) after drug-eluting stent (DES) implantation. Methods: We enrolled 744 lesions treated with either sirolimuseluting stents (SES; 79%) or paclitaxel-eluting stents (PES; 21%) that underwent 6-month and 2-year angiographies. CAA was defined as

The American Journal of Cardiology姞 APRIL 22–24 2009 ANGIOPLASTY SUMMIT ABSTRACTS/E-Poster 77B

EP O S T E R A B S T R A C T S