- Email: [email protected]
TCT-654: Quantitative multi-modality imaging analysis of a fully bioresorbable scaffold: a head-to-head comparison between QCA, IVUS and OCT
www.JACC.TCTAbstracts2011
TUESDAY, NOVEMBER 8, 2011, 8:00 AM - 10:00 AM
TCT-653 Conclusion: There was very good correlation between the presence, absence, and spatial distribution of lipid pools as noted on OCT and NIRS imaging. Larger studies are required to determine whether NIRS and OCT provide complementary information for plaque characterization.
TCT-651 Assessment of the bioresorption process utilising intravascular ultrasound derived echogenicity analyses and vasomotion testing of the ABSORB bioresorbable everolimus-eluting vascular scaffold. A substudy of the ABSORB Cohort B trial Jung Ho Heo1, 4, Salvatore Brugaletta1, 2, Yoshinobu Onuma1, 3, Vasim Farooq1, Nico. Bruining1, Hector M. Garcia-Garcia1, 3, Patrick W. Serruys1 1 Thoraxcenter, Erasmus university, Rotterdam, Netherlands; 2Hospital Clinic I Provincial, barcelona, Spain; 3Cardialysis, Rotterdam, Netherlands; 4Kosin University Hospital, Busan, Republic of Korea Background: Reduction in the hyper-echogenicity characteristics of the ABSORB scaffold has been demonstrated to be related to the recovery of vasoreactivity of the scaffolded segment at 2 years. Subsequent changes in the platform design and manufacturing processes lead to significant prolongation in the lumen support with a new revision of the device . We sought to correlate the reduction in hyper-echogenicity of the revised ABSORB with the recovery of vaso-reactivity of the scaffolded segment during this time period. Methods: All patients from the ABSORB trial, who underwent paired echogenicity analyses and vasomotion testing at 6 (ABSORB Cohort B1) or 12 (ABSORB Cohort B2) months follow-up, were included in the analysis. Vasoreactivity was calculated as relative mean lumen diameter (MLD) changes from pre to post acetylcholine administration Results: Overall, 31 patients underwent paired IVUS derived echogenicity analyses and vasomotion testing at 6 (n=14) and 12-month (n=17) follow-up respectively. The reduction in hyper-echogenicity of the scaffolded segment in the acetylcholine test group went from 20.04±10.01 % to 18.09±10.01%, (p=0.561) and from 23.89 ± 9.99 % to 18.16 ± 8.70 % (p=0.006) at 6 and 12 months, respectively. The changes in MLD after administration of acethylcoline were 1% of vasodilation (p=0.405 ) and 4% vasoconstriction (p=0.086) at 6 and 12 months, respectively. A significant relationship between the changes in hyper-echogenicity and in MLD after acethylcoline administration was demonstrated at 12 months (Spearman rho=-0.678, p=0.0154), but not at 6 months (Spearman rho=-0.3778, p=0.252) Conclusion: The reduction in hyperechogenecity of the scaffolded segment is significantly correlated with the restoration of the vasomotor activities of a coronary segment scaffolded by the ABSORB scaffold at a long-term follow-up. This is consistent with the programmed loss of structural integrity of the scaffold at that time point.
TCT-652 In Vivo Distribution Of Lipid Core Containing Plaque According To Distance From The Ostium By Near Infrared Spectroscopy In Non-cuprit Coronary Arteries Salvatore Brugaletta1, 2, Hector M Garcia-Garcia1, Patrick W Serruys1, Josep Gomez-Lara1, Sanneke de Boer1, Jurgen Ligthart1, Karen Witberg1, Cihan Simsek1, Robert Jan van Geuns1, Carl Schultz1, Henricus J. Duckers1, Nicolas van Mieghem1, Peter de Jaegere1, Sean P Madden3, James E Muller3, Antonius van der Steen1, Eric Boersma1, Wim J. van der Giessen1, Felix Zijlstra1, Evelyn Regar1 1 Thoraxcenter, Erasmus MC, Rotterdam, Netherlands; 2Thorax Institute Hospital Clinic, Barcelona, Spain; 3InfraReDx, Burlington, MA Background: Anatomo-pathological data indicate that coronary plaques prone to rupture and erosion tend to cluster within the proximal third of each coronary vessel. Intracoronary NIRS is a novel method to detect lipid core plaques (LCP). We sought to assess the spatial distribution of lipid core plaques (LCP) by means of near infra red spectroscopy (NIRS) in coronary arteries. Methods: Sixty-eight consecutive patients underwent NIRS imaging on a non culprit
Quantitative and Qualitative Changes of Neointimal Tissue in Drug Eluting Stents [Serial (9 Months and 2 Years) Observation using Intracoronary Optical Coherence Tomography] Jung-Sun Kim, Dong-Ho Shin, Byeong-Keuk Kim, Young-Guk Ko, Donghoon Choi, Yangsoo Jang, Myeong-Ki Hong Division of Cardiology, Severance Cardiovascular Hospital, Yonsei University College of Medicine, Seoul, Republic of Korea Background: The long-term serial change of stent strut coverage and neointima characteristics in DESs have not been fully investigated with OCT. This study tried to evaluate the serial quantitative and qualitative changes of vascular response in drug eluting stents (DES) at 9 months and 2 years using optical coherence tomography (OCT). Methods: The OCT was performed serially in 80 DESs of 76 patients at 9 months and 2 years after DESs implantation (sirolimus-eluting stent [SES], n=23; paclitaxel-eluting stent [PES], n=20; zotarolimus-eluting stent [ZES], n=25, everolimus-eluting stent [EES], n=12). Serial change of quantitative (neointimal thickness, stent strut coverage and apposition at each strut) and qualitative characteristics were evaluated. Results: The incidence of uncovered stent strut significantly decreases from 9 months to 2 years follow-up (4.9 % to 2.6 %, p<0.001), but there was similar for malapposition rate (1.0 % to 1.1 %, p=0.63) and incidence of intracoronary thrombi (10.0 % to 8.8 %, p=0.79). In qualitative evaluation, lipid laden neointima (13.8% to 26.3%, p=0.03) and intimal disruption (13.8% to 33.8%, p=0.03) were more frequently detected at 2 years follow-up compared to 9 months follow-up. Conclusion: This OCT study suggested that neointimal coverage improved from 9 months to 2 years, but prevalence of malappostion and thrombus was not changed during extended follow-up. Additionally, the neoatherosclerosis including transforming into lipid laden neointima might progress between 9 months and 2 year-follow period.
TCT-654 Quantitative multi-modality imaging analysis of a fully bioresorbable scaffold: a head-to-head comparison between QCA, IVUS and OCT Juan Luis Gutiérrez-Chico1, Patrick W Serruys1, Chrysafios Girasis1, Yoshinobu Onuma1, Salvatore Brugaletta1, Héctor Manuel García-García2, Evelyn Regar1 1 Interventional Cardiology, Erasmus Medical Center - Thoraxcenter, Rotterdam, Netherlands; 2Cardialysis BV, Rotterdam, Netherlands Background: The bioresorbable vascular scaffold (BVS) has peculiar imaging characteristics, like total translucency and radiolucency. We analyze the agreement between QCA, IVUS and OCT in the BVS for length and minimum lumen area (MLA) measurements immediately post-implantation and at 6 months. Methods: Patients enrolled in the ABSORB cohort B1 study (NCT00856856) underwent coronary angiography, IVUS and OCT immediately post BVS implantation and at 6 months. Agreement between QCA edge detection (ED), QCA videodensitometry (VD), IVUS and OCT regarding scaffold length and MLA was analyzed through intraclass correlation coefficients and Passing-Bablock nonparametric orthogonal regression. Results: 45 patients were sequentially imaged. OCT estimates scaffold length accurately compared to nominal length (95% CI of the difference: -0.15; 0.34 and 0.13; 0.47mm for baseline and 6 months, respectively), whereas QCA incurs consistent underestimation of the same magnitude at both time points (Pearson correlation = 0.806). IVUS yields low accuracy (95% CI of the difference: 1.04; 3.24 and -0.56; 2.65mm2 for baseline and 6 months, respectively), with several outliers and random variability test-retest. MLA decreases substantially between baseline and 6 months in QCA and OCT, but only minimally in IVUS (95% CI: 0.12, 0.52 mm2). ICCa and Bland-Altman show poor agreement for MLA between the different imaging modalities: worst agreement ED-IVUS post-implantation (ICCa 0.253); best agreement IVUS-OCT at 6 months (ICCa 0.767). All the pairs deviated significantly from linearity (p<0.01). Passing-Bablock non-parametric orthogonal regression showed constant and proportional bias between IVUS and OCT. Conclusion: OCT is the most accurate technique for measurement of scaffold length; QCA incurs systematic underestimation (foreshortening) and IVUS is the most inaccurate and unpredictable modality. This has implications for volumetric
JACC Vol 58/20/Suppl B | November 7-11, 2011 | TCT Abstracts/POSTER/Intravascular Imaging: IVUS, OCT, Spectroscopy, and Other
B175
POSTERS
coronary artery. The region of interest (ROI) was subsequently divided into 10-mm segments from proximal to distal. The 2-mm long block chemogram value (probability of LCP, ranging from 0–low probability- to 1 –high probability) was assessed per ROI and per each 10-mm segment. Results: Overall, the length of the ROI was 58.0±4.3 mm, subdivided into 10-mm segments for a total of 392 analyzed segments. There was a progressive decrease of LCP from proximal to distal in the various 10-mm segments (1st 0.41[0.34-0.48] vs. 2nd 0.35[0.29-0.42] vs. 3rd 0.37[0.30-0.43] vs. 4th 0.32[0.26-0.39] vs. 5th 0.26[0.200.33] vs. 6th 0.26[0.19-0.33], p=0.011). While in LAD and in LCx, LCP tended to cluster in the proximal segment (p<0.001 and p=0.001, respectively), in the RCA they were evenly distributed along the artery (p=0.155). At logistic regression analysis, distance from the ostium was the only independent predictor of LCP. Conclusion: Lipid-core plaques, as detected by NIRS, cluster in the proximal segment of the coronary arteries, in distribution similar to that observed in prior autopsy studies. The distribution of LCP is similar to that of the culprit lesions of STEMI patients.
www.JACC.TCTAbstracts2011
TUESDAY, NOVEMBER 8, 2011, 8:00 AM - 10:00 AM
POSTERS
calculations. There is poor agreement for MLA estimation between all the imaging modalities studied, including IVUS-OCT, thus their values are not interchangeable.
TCT-655 Effectiveness of thrombo-aspiration therapy in patient with acute myocardial infarction; an optical coherence tomography study Takashi Kubo, Kunihiro Shimamura, Yasutsugu Shiono, Makoto Orii, Hiromichi Sougawa, Takashi Yamano, Yasushi Ino, Takashi Tanimoto, Kohei Ishibashi, Kenichi Komukai, Hironori Kitabata, Shigeho Takarada, Atsushi Tanaka, Keizo Kimura, Toshio Imanishi, Takashi Akasaka Department of Cardiovascular Medicine, Wakayama Medical University, Wakayama, Japan
TCT-657 Assessment of Atherosclerosis at Coronary Bifurcations with Multislice Computed Tomography and Intravascular Ultrasound-Virtual Histology Stella-Lida Papadopoulou1, Salvatore Brugaletta2, Hector M Garcia-Garcia2, Pim J de Feyter1, Patrick W Serruys2 1 Cardiology & Radiology, Erasmus MC, Rotterdam, Netherlands; 2Interventional Cardiology, Erasmus MC, Rotterdam, Netherlands
Background: Background- Manual thrombus aspiration is a helpful adjunctive therapy of percutaneous coronary intervention (PCI) in patients with ST-segment elevation myocardial infarction (STEMI). Previous studies have demonstrated that tissue protrusion within the stent is associated with clinical outcomes after PCI. We used optical coherence tomography (OCT) to evaluate the impact of thrombus aspiration prior to balloon or stent angioplasty on tissue protrusions after stenting in patients with STEMI. Methods: Methods- A total of 101 patients with STEMI who underwent standard PCI (n=41) or thrombus-aspiration PCI (n=60) were examined in the present study. Mean duration between symptom onset and primary PCI was 5.7 ± 4.2 hours. OCT was performed after PCI to assess lesion morphology in the stented segment. Results: Results- Baseline patient characteristics and stent profiles were comparable between the thrombus-aspiration and the standard PCI group. After primary PCI, TIMI flow grade >2 was attained in 92% in the thrombus-aspiration group compared with 90% in the standard PCI group (P>0.9). OCT measurements at maximl tissue protrusion area site demonstrated similar stent area (8.1 ± 2.8 mm2 vs. 7.6 ± 2.7 mm2, p=0.7), significantly smaller tissue protrusion area (0.5 ± 1.0 mm2 vs. 1.8 ± 1.6 mm2, p<0.05) and significantly greater lumen area (7.6 ± 2.6 mm2 vs. 5.7 ± 2.7 mm2, p<0.05) in the thrombus-aspiration PCI group compared to the standard PCI group. Conclusion: Conclusions- Thrombus aspiration prior to balloon or stent angioplasty in patients with STEMI prevents tissue protrusion after stening and preserves luminal area in the treated segment, and it therefore represents a useful adjunctive therapy in primary PCI.
Background: Pathological examinations have shown that high-risk plaques are prone to develop at bifurcations. We sought to evaluate the distribution and composition of atherosclerotic plaque at bifurcations with intravascular ultrasound–virtual histology (IVUS-VH) and multislice computed tomography (MSCT) and examine any potential influence of the bifurcation angle (BA). Methods: From 25 patients (age 62±11 yrs, 80% male) imaged with IVUS-VH and MSCT, 25 bifurcations were matched and studied. For the analysis, the main vessel was divided into proximal 5mm segment, in-bifurcation segment and distal 5mm segment. Plaques were independently measured in MSCT by manually tracing plaque contours in serial cross-sectional reconstructions and in IVUS-VH by manual tracing of plaque borders. Plaques with >10% confluent necrotic core and <10% dense calcium by IVUS-VH were classified as fibroatheroma or thin-cap fibroatheroma and considered high-risk. Plaque composition by MSCT was graded as non-calcified, calcified (>50% calcium) or mixed. The BA was measured by MSCT on the multiplanar reconstruction view in which the angulation between the main vessel and side branch was maximal, using only diastolic datasets. Results: Overall the mean plaque area decreases from proximal to distal segment (8.2±2.9 vs. 5.4±3.0 mm2 respectively by IVUS-VH, p<0.001 and 8.5±2.5 vs. 6.1±2.5 mm2 by MSCT, p<0.001). The percentage of necrotic core is higher in the proximal segment (21.2% vs. 15.4% respectively, p=0.017). The high-risk plaques were more often located in the proximal segment (8 of 16, 50%), followed by the in-bifurcation (4 of 16, 25%) and the distal segment (4 of 16, 25%). These plaques were characterized by MSCT as non-calcified (81%) and mixed (19%). The BA was wider for high-risk than other plaques at the proximal segment (73±19 vs. 54±19 degrees respectively, p=0.03) and for the non-calcified plaques vs. mixed/calcified (75±19 vs. 47±11 degrees, p=0.002). Conclusion: The proximal segment of bifurcations is more likely to contain high-risk plaques, especially when the BA is wide.
TCT-656
TCT-658
Relation between the multivessel disease and culprit lesion morphology in acute coronary syndrome -An optical coherence tomography study-
Differential Healing Response in Acute Coronary Syndrome Versus Stable Coronary Artery Disease Patients 5 Years Following Early Generation DES Implantation: An Optical Coherence Tomography Study
Kenichiro Saka1, Kiyoshi Hibi1, Nobuhiko Maejima1, Tomokazu Sakano1, Yasushi Matsuzawa1, Noriaki Iwahashi1, Mitsuaki Endo1, Kengo Tsukahara1, Masaaki Ebina1, Satoshi Umemura2, Kazuo Kimura1 1 Yokohama City University Medical Center, Yokohama, Japan; 2Yokohama City University Graduate School of Medicine, Department of Medical Science and Cardiorenal Medicine, Yokohama, Japan Background: Several studies have demonstrated that multivessel disease (MVD) was an independent predictor for coronary plaque progression and recurrent acute coronary events. Optical coherence tomography (OCT) is a feasible technique for the identification of thin-cap fibroatheroma (TCFA) in vivo. The aim of this study was to examine the relation between MVD and culprit lesion morphology as determined by OCT in patients with acute coronary syndrome (ACS). Methods: A total of 124 culprit plaques in 124 patients with ACS (34 patients with AMI and 90 patients with unstable angina pectoris) were interrogated by OCT before percutaneous coronary intervention. Minimum fibrous cap thickness and mean fibrous cap thickness of the most diseased 10 mm segment (at 1 mm intervals) in the culprit lesion were measured by OCT. Lipid-rich plaque was defined as a plaque with lipid in 2 or more quadrants, and TCFA was defined as a lipid-rich plaque with fibrous cap thickness< 65 μm. Results: Coronary plaques of single, double, and triple vessel disease were identified in 67 (54%), 38 (31%), and 19 patients (15%), respectively. Culprit plaques in patients with MVD had significantly thinner minimum and mean fibrous cap thickness compared with those with single vessel disease (56 vs 77 μm, P<0.001 and 138 vs 175 μm, P<0.001, respectively). The frequency of TCFA (81% vs 51%, P=0.001), plaque rupture (67% vs 39%, P=0.002), thrombus (91% vs 75%, P=0.014), and lipid-rich plaques (93% vs 70%, P=0.001) were higher in patients with MVD than in those with single vessel disease. Multiple plaque rupture in the culprit vessel were observed more frequently in patients with MVD than in those with single vessel disease (18% vs 5%, P=0.018). Conclusion: In patients with ACS, MVD was associated with more vulnerable culprit plaque morphology as compared with those with single vessel disease. Therefore, patients with MVD may have heightened coronary vulnerability and may require more detailed assessment and more aggressive therapy even after successful treatment for culprit lesions.
B176
Lorenz Raber1, Bindu Kalesan2, 3, Sandro Baumgartner1, Hector M Garcia Garcia4, Thomas Pilgrim1, Jörn Justiz5, Peter Wenaweser1, Giulio G Stefanini1, Aris Moschovitis1, Lutz Buellesfeld1, Ahmed A Khattab1, Bernhard Meier1, Peter Juni2, 3, Patrick W Serruys4, Stephan Windecker1, 3 1 Department of Cardiology, Bern University Hospital, Bern, Switzerland; 2Institute of Social and Preventive Medicine, University of Bern, Bern, Switzerland; 3Clinical Trials Unit, Bern University Hospital, Bern, Switzerland; 4Thoraxcenter, Erasmus MC, Rotterdam, Netherlands; 5University of Applied Science, Biel, Switzerland Background: Patients with acute coronary syndromes (ACS) have a higher risk of very late stent thrombosis after implantation of early generation drug-eluting stent (DES) compared with patients with stable coronary artery disease. Post-mortem studies of patients treated with DES observed less complete strut coverage, more inflammation and fibrin deposition among ACS compared with stable CAD patients. Using optical coherence tomography, we compared stent strut coverage, protrusion, and malapposition as markers of vascular healing (OCT) between ACS and stable CAD patients 5 years after implantation of early generation DES. Methods: A total of 88 patients with one lesion were suitable for final OCT analysis five years after DES implantation. The analytical approach was based on a hierarchical Bayesian random-effects model and compared strut coverage, protrusion and malapposition between ACS and stable CAD patients. The analysis was adjusted for differences in baseline patient characteristics (hypertension, hyperlipidemia, left ventricular function) and stent type. Results: OCT analysis was performed in 53 ACS culprit lesions with 7,864 struts, and in 35 stable lesions with 5’298 struts. A total of 284 (1.73%) struts were uncovered in ACS culprit lesions compared to 97 struts (0.7%) in stable lesions, (adjusted p=0.041). Malapposed struts were present in 303 (1.33%) of ACS culprit lesions as compared with 106 (0.45%) of stable lesions (adjusted p=0.072). Protruding struts were more frequent among ACS culprit lesions 106 (0.50%) than stable lesions 0.34 (0.13%), (adjusted p=0.038). Conclusion: Uncovered, malapposed and protruding struts are more frequent in culprit lesions of ACS patients compared with lesions of stable CAD patients 5 years after implantation of early generation DES. These findings suggest a differential healing response of ACS compared with stable CAD patients.
JACC Vol 58/20/Suppl B | November 7-11, 2011 | TCT Abstracts/POSTER/Intravascular Imaging: IVUS, OCT, Spectroscopy, and Other
TUESDAY, NOVEMBER 8, 2011, 8:00 AM - 10:00 AM
TCT-653 Conclusion: There was very good correlation between the presence, absence, and spatial distribution of lipid pools as noted on OCT and NIRS imaging. Larger studies are required to determine whether NIRS and OCT provide complementary information for plaque characterization.
TCT-651 Assessment of the bioresorption process utilising intravascular ultrasound derived echogenicity analyses and vasomotion testing of the ABSORB bioresorbable everolimus-eluting vascular scaffold. A substudy of the ABSORB Cohort B trial Jung Ho Heo1, 4, Salvatore Brugaletta1, 2, Yoshinobu Onuma1, 3, Vasim Farooq1, Nico. Bruining1, Hector M. Garcia-Garcia1, 3, Patrick W. Serruys1 1 Thoraxcenter, Erasmus university, Rotterdam, Netherlands; 2Hospital Clinic I Provincial, barcelona, Spain; 3Cardialysis, Rotterdam, Netherlands; 4Kosin University Hospital, Busan, Republic of Korea Background: Reduction in the hyper-echogenicity characteristics of the ABSORB scaffold has been demonstrated to be related to the recovery of vasoreactivity of the scaffolded segment at 2 years. Subsequent changes in the platform design and manufacturing processes lead to significant prolongation in the lumen support with a new revision of the device . We sought to correlate the reduction in hyper-echogenicity of the revised ABSORB with the recovery of vaso-reactivity of the scaffolded segment during this time period. Methods: All patients from the ABSORB trial, who underwent paired echogenicity analyses and vasomotion testing at 6 (ABSORB Cohort B1) or 12 (ABSORB Cohort B2) months follow-up, were included in the analysis. Vasoreactivity was calculated as relative mean lumen diameter (MLD) changes from pre to post acetylcholine administration Results: Overall, 31 patients underwent paired IVUS derived echogenicity analyses and vasomotion testing at 6 (n=14) and 12-month (n=17) follow-up respectively. The reduction in hyper-echogenicity of the scaffolded segment in the acetylcholine test group went from 20.04±10.01 % to 18.09±10.01%, (p=0.561) and from 23.89 ± 9.99 % to 18.16 ± 8.70 % (p=0.006) at 6 and 12 months, respectively. The changes in MLD after administration of acethylcoline were 1% of vasodilation (p=0.405 ) and 4% vasoconstriction (p=0.086) at 6 and 12 months, respectively. A significant relationship between the changes in hyper-echogenicity and in MLD after acethylcoline administration was demonstrated at 12 months (Spearman rho=-0.678, p=0.0154), but not at 6 months (Spearman rho=-0.3778, p=0.252) Conclusion: The reduction in hyperechogenecity of the scaffolded segment is significantly correlated with the restoration of the vasomotor activities of a coronary segment scaffolded by the ABSORB scaffold at a long-term follow-up. This is consistent with the programmed loss of structural integrity of the scaffold at that time point.
TCT-652 In Vivo Distribution Of Lipid Core Containing Plaque According To Distance From The Ostium By Near Infrared Spectroscopy In Non-cuprit Coronary Arteries Salvatore Brugaletta1, 2, Hector M Garcia-Garcia1, Patrick W Serruys1, Josep Gomez-Lara1, Sanneke de Boer1, Jurgen Ligthart1, Karen Witberg1, Cihan Simsek1, Robert Jan van Geuns1, Carl Schultz1, Henricus J. Duckers1, Nicolas van Mieghem1, Peter de Jaegere1, Sean P Madden3, James E Muller3, Antonius van der Steen1, Eric Boersma1, Wim J. van der Giessen1, Felix Zijlstra1, Evelyn Regar1 1 Thoraxcenter, Erasmus MC, Rotterdam, Netherlands; 2Thorax Institute Hospital Clinic, Barcelona, Spain; 3InfraReDx, Burlington, MA Background: Anatomo-pathological data indicate that coronary plaques prone to rupture and erosion tend to cluster within the proximal third of each coronary vessel. Intracoronary NIRS is a novel method to detect lipid core plaques (LCP). We sought to assess the spatial distribution of lipid core plaques (LCP) by means of near infra red spectroscopy (NIRS) in coronary arteries. Methods: Sixty-eight consecutive patients underwent NIRS imaging on a non culprit
Quantitative and Qualitative Changes of Neointimal Tissue in Drug Eluting Stents [Serial (9 Months and 2 Years) Observation using Intracoronary Optical Coherence Tomography] Jung-Sun Kim, Dong-Ho Shin, Byeong-Keuk Kim, Young-Guk Ko, Donghoon Choi, Yangsoo Jang, Myeong-Ki Hong Division of Cardiology, Severance Cardiovascular Hospital, Yonsei University College of Medicine, Seoul, Republic of Korea Background: The long-term serial change of stent strut coverage and neointima characteristics in DESs have not been fully investigated with OCT. This study tried to evaluate the serial quantitative and qualitative changes of vascular response in drug eluting stents (DES) at 9 months and 2 years using optical coherence tomography (OCT). Methods: The OCT was performed serially in 80 DESs of 76 patients at 9 months and 2 years after DESs implantation (sirolimus-eluting stent [SES], n=23; paclitaxel-eluting stent [PES], n=20; zotarolimus-eluting stent [ZES], n=25, everolimus-eluting stent [EES], n=12). Serial change of quantitative (neointimal thickness, stent strut coverage and apposition at each strut) and qualitative characteristics were evaluated. Results: The incidence of uncovered stent strut significantly decreases from 9 months to 2 years follow-up (4.9 % to 2.6 %, p<0.001), but there was similar for malapposition rate (1.0 % to 1.1 %, p=0.63) and incidence of intracoronary thrombi (10.0 % to 8.8 %, p=0.79). In qualitative evaluation, lipid laden neointima (13.8% to 26.3%, p=0.03) and intimal disruption (13.8% to 33.8%, p=0.03) were more frequently detected at 2 years follow-up compared to 9 months follow-up. Conclusion: This OCT study suggested that neointimal coverage improved from 9 months to 2 years, but prevalence of malappostion and thrombus was not changed during extended follow-up. Additionally, the neoatherosclerosis including transforming into lipid laden neointima might progress between 9 months and 2 year-follow period.
TCT-654 Quantitative multi-modality imaging analysis of a fully bioresorbable scaffold: a head-to-head comparison between QCA, IVUS and OCT Juan Luis Gutiérrez-Chico1, Patrick W Serruys1, Chrysafios Girasis1, Yoshinobu Onuma1, Salvatore Brugaletta1, Héctor Manuel García-García2, Evelyn Regar1 1 Interventional Cardiology, Erasmus Medical Center - Thoraxcenter, Rotterdam, Netherlands; 2Cardialysis BV, Rotterdam, Netherlands Background: The bioresorbable vascular scaffold (BVS) has peculiar imaging characteristics, like total translucency and radiolucency. We analyze the agreement between QCA, IVUS and OCT in the BVS for length and minimum lumen area (MLA) measurements immediately post-implantation and at 6 months. Methods: Patients enrolled in the ABSORB cohort B1 study (NCT00856856) underwent coronary angiography, IVUS and OCT immediately post BVS implantation and at 6 months. Agreement between QCA edge detection (ED), QCA videodensitometry (VD), IVUS and OCT regarding scaffold length and MLA was analyzed through intraclass correlation coefficients and Passing-Bablock nonparametric orthogonal regression. Results: 45 patients were sequentially imaged. OCT estimates scaffold length accurately compared to nominal length (95% CI of the difference: -0.15; 0.34 and 0.13; 0.47mm for baseline and 6 months, respectively), whereas QCA incurs consistent underestimation of the same magnitude at both time points (Pearson correlation = 0.806). IVUS yields low accuracy (95% CI of the difference: 1.04; 3.24 and -0.56; 2.65mm2 for baseline and 6 months, respectively), with several outliers and random variability test-retest. MLA decreases substantially between baseline and 6 months in QCA and OCT, but only minimally in IVUS (95% CI: 0.12, 0.52 mm2). ICCa and Bland-Altman show poor agreement for MLA between the different imaging modalities: worst agreement ED-IVUS post-implantation (ICCa 0.253); best agreement IVUS-OCT at 6 months (ICCa 0.767). All the pairs deviated significantly from linearity (p<0.01). Passing-Bablock non-parametric orthogonal regression showed constant and proportional bias between IVUS and OCT. Conclusion: OCT is the most accurate technique for measurement of scaffold length; QCA incurs systematic underestimation (foreshortening) and IVUS is the most inaccurate and unpredictable modality. This has implications for volumetric
JACC Vol 58/20/Suppl B | November 7-11, 2011 | TCT Abstracts/POSTER/Intravascular Imaging: IVUS, OCT, Spectroscopy, and Other
B175
POSTERS
coronary artery. The region of interest (ROI) was subsequently divided into 10-mm segments from proximal to distal. The 2-mm long block chemogram value (probability of LCP, ranging from 0–low probability- to 1 –high probability) was assessed per ROI and per each 10-mm segment. Results: Overall, the length of the ROI was 58.0±4.3 mm, subdivided into 10-mm segments for a total of 392 analyzed segments. There was a progressive decrease of LCP from proximal to distal in the various 10-mm segments (1st 0.41[0.34-0.48] vs. 2nd 0.35[0.29-0.42] vs. 3rd 0.37[0.30-0.43] vs. 4th 0.32[0.26-0.39] vs. 5th 0.26[0.200.33] vs. 6th 0.26[0.19-0.33], p=0.011). While in LAD and in LCx, LCP tended to cluster in the proximal segment (p<0.001 and p=0.001, respectively), in the RCA they were evenly distributed along the artery (p=0.155). At logistic regression analysis, distance from the ostium was the only independent predictor of LCP. Conclusion: Lipid-core plaques, as detected by NIRS, cluster in the proximal segment of the coronary arteries, in distribution similar to that observed in prior autopsy studies. The distribution of LCP is similar to that of the culprit lesions of STEMI patients.
www.JACC.TCTAbstracts2011
TUESDAY, NOVEMBER 8, 2011, 8:00 AM - 10:00 AM
POSTERS
calculations. There is poor agreement for MLA estimation between all the imaging modalities studied, including IVUS-OCT, thus their values are not interchangeable.
TCT-655 Effectiveness of thrombo-aspiration therapy in patient with acute myocardial infarction; an optical coherence tomography study Takashi Kubo, Kunihiro Shimamura, Yasutsugu Shiono, Makoto Orii, Hiromichi Sougawa, Takashi Yamano, Yasushi Ino, Takashi Tanimoto, Kohei Ishibashi, Kenichi Komukai, Hironori Kitabata, Shigeho Takarada, Atsushi Tanaka, Keizo Kimura, Toshio Imanishi, Takashi Akasaka Department of Cardiovascular Medicine, Wakayama Medical University, Wakayama, Japan
TCT-657 Assessment of Atherosclerosis at Coronary Bifurcations with Multislice Computed Tomography and Intravascular Ultrasound-Virtual Histology Stella-Lida Papadopoulou1, Salvatore Brugaletta2, Hector M Garcia-Garcia2, Pim J de Feyter1, Patrick W Serruys2 1 Cardiology & Radiology, Erasmus MC, Rotterdam, Netherlands; 2Interventional Cardiology, Erasmus MC, Rotterdam, Netherlands
Background: Background- Manual thrombus aspiration is a helpful adjunctive therapy of percutaneous coronary intervention (PCI) in patients with ST-segment elevation myocardial infarction (STEMI). Previous studies have demonstrated that tissue protrusion within the stent is associated with clinical outcomes after PCI. We used optical coherence tomography (OCT) to evaluate the impact of thrombus aspiration prior to balloon or stent angioplasty on tissue protrusions after stenting in patients with STEMI. Methods: Methods- A total of 101 patients with STEMI who underwent standard PCI (n=41) or thrombus-aspiration PCI (n=60) were examined in the present study. Mean duration between symptom onset and primary PCI was 5.7 ± 4.2 hours. OCT was performed after PCI to assess lesion morphology in the stented segment. Results: Results- Baseline patient characteristics and stent profiles were comparable between the thrombus-aspiration and the standard PCI group. After primary PCI, TIMI flow grade >2 was attained in 92% in the thrombus-aspiration group compared with 90% in the standard PCI group (P>0.9). OCT measurements at maximl tissue protrusion area site demonstrated similar stent area (8.1 ± 2.8 mm2 vs. 7.6 ± 2.7 mm2, p=0.7), significantly smaller tissue protrusion area (0.5 ± 1.0 mm2 vs. 1.8 ± 1.6 mm2, p<0.05) and significantly greater lumen area (7.6 ± 2.6 mm2 vs. 5.7 ± 2.7 mm2, p<0.05) in the thrombus-aspiration PCI group compared to the standard PCI group. Conclusion: Conclusions- Thrombus aspiration prior to balloon or stent angioplasty in patients with STEMI prevents tissue protrusion after stening and preserves luminal area in the treated segment, and it therefore represents a useful adjunctive therapy in primary PCI.
Background: Pathological examinations have shown that high-risk plaques are prone to develop at bifurcations. We sought to evaluate the distribution and composition of atherosclerotic plaque at bifurcations with intravascular ultrasound–virtual histology (IVUS-VH) and multislice computed tomography (MSCT) and examine any potential influence of the bifurcation angle (BA). Methods: From 25 patients (age 62±11 yrs, 80% male) imaged with IVUS-VH and MSCT, 25 bifurcations were matched and studied. For the analysis, the main vessel was divided into proximal 5mm segment, in-bifurcation segment and distal 5mm segment. Plaques were independently measured in MSCT by manually tracing plaque contours in serial cross-sectional reconstructions and in IVUS-VH by manual tracing of plaque borders. Plaques with >10% confluent necrotic core and <10% dense calcium by IVUS-VH were classified as fibroatheroma or thin-cap fibroatheroma and considered high-risk. Plaque composition by MSCT was graded as non-calcified, calcified (>50% calcium) or mixed. The BA was measured by MSCT on the multiplanar reconstruction view in which the angulation between the main vessel and side branch was maximal, using only diastolic datasets. Results: Overall the mean plaque area decreases from proximal to distal segment (8.2±2.9 vs. 5.4±3.0 mm2 respectively by IVUS-VH, p<0.001 and 8.5±2.5 vs. 6.1±2.5 mm2 by MSCT, p<0.001). The percentage of necrotic core is higher in the proximal segment (21.2% vs. 15.4% respectively, p=0.017). The high-risk plaques were more often located in the proximal segment (8 of 16, 50%), followed by the in-bifurcation (4 of 16, 25%) and the distal segment (4 of 16, 25%). These plaques were characterized by MSCT as non-calcified (81%) and mixed (19%). The BA was wider for high-risk than other plaques at the proximal segment (73±19 vs. 54±19 degrees respectively, p=0.03) and for the non-calcified plaques vs. mixed/calcified (75±19 vs. 47±11 degrees, p=0.002). Conclusion: The proximal segment of bifurcations is more likely to contain high-risk plaques, especially when the BA is wide.
TCT-656
TCT-658
Relation between the multivessel disease and culprit lesion morphology in acute coronary syndrome -An optical coherence tomography study-
Differential Healing Response in Acute Coronary Syndrome Versus Stable Coronary Artery Disease Patients 5 Years Following Early Generation DES Implantation: An Optical Coherence Tomography Study
Kenichiro Saka1, Kiyoshi Hibi1, Nobuhiko Maejima1, Tomokazu Sakano1, Yasushi Matsuzawa1, Noriaki Iwahashi1, Mitsuaki Endo1, Kengo Tsukahara1, Masaaki Ebina1, Satoshi Umemura2, Kazuo Kimura1 1 Yokohama City University Medical Center, Yokohama, Japan; 2Yokohama City University Graduate School of Medicine, Department of Medical Science and Cardiorenal Medicine, Yokohama, Japan Background: Several studies have demonstrated that multivessel disease (MVD) was an independent predictor for coronary plaque progression and recurrent acute coronary events. Optical coherence tomography (OCT) is a feasible technique for the identification of thin-cap fibroatheroma (TCFA) in vivo. The aim of this study was to examine the relation between MVD and culprit lesion morphology as determined by OCT in patients with acute coronary syndrome (ACS). Methods: A total of 124 culprit plaques in 124 patients with ACS (34 patients with AMI and 90 patients with unstable angina pectoris) were interrogated by OCT before percutaneous coronary intervention. Minimum fibrous cap thickness and mean fibrous cap thickness of the most diseased 10 mm segment (at 1 mm intervals) in the culprit lesion were measured by OCT. Lipid-rich plaque was defined as a plaque with lipid in 2 or more quadrants, and TCFA was defined as a lipid-rich plaque with fibrous cap thickness< 65 μm. Results: Coronary plaques of single, double, and triple vessel disease were identified in 67 (54%), 38 (31%), and 19 patients (15%), respectively. Culprit plaques in patients with MVD had significantly thinner minimum and mean fibrous cap thickness compared with those with single vessel disease (56 vs 77 μm, P<0.001 and 138 vs 175 μm, P<0.001, respectively). The frequency of TCFA (81% vs 51%, P=0.001), plaque rupture (67% vs 39%, P=0.002), thrombus (91% vs 75%, P=0.014), and lipid-rich plaques (93% vs 70%, P=0.001) were higher in patients with MVD than in those with single vessel disease. Multiple plaque rupture in the culprit vessel were observed more frequently in patients with MVD than in those with single vessel disease (18% vs 5%, P=0.018). Conclusion: In patients with ACS, MVD was associated with more vulnerable culprit plaque morphology as compared with those with single vessel disease. Therefore, patients with MVD may have heightened coronary vulnerability and may require more detailed assessment and more aggressive therapy even after successful treatment for culprit lesions.
B176
Lorenz Raber1, Bindu Kalesan2, 3, Sandro Baumgartner1, Hector M Garcia Garcia4, Thomas Pilgrim1, Jörn Justiz5, Peter Wenaweser1, Giulio G Stefanini1, Aris Moschovitis1, Lutz Buellesfeld1, Ahmed A Khattab1, Bernhard Meier1, Peter Juni2, 3, Patrick W Serruys4, Stephan Windecker1, 3 1 Department of Cardiology, Bern University Hospital, Bern, Switzerland; 2Institute of Social and Preventive Medicine, University of Bern, Bern, Switzerland; 3Clinical Trials Unit, Bern University Hospital, Bern, Switzerland; 4Thoraxcenter, Erasmus MC, Rotterdam, Netherlands; 5University of Applied Science, Biel, Switzerland Background: Patients with acute coronary syndromes (ACS) have a higher risk of very late stent thrombosis after implantation of early generation drug-eluting stent (DES) compared with patients with stable coronary artery disease. Post-mortem studies of patients treated with DES observed less complete strut coverage, more inflammation and fibrin deposition among ACS compared with stable CAD patients. Using optical coherence tomography, we compared stent strut coverage, protrusion, and malapposition as markers of vascular healing (OCT) between ACS and stable CAD patients 5 years after implantation of early generation DES. Methods: A total of 88 patients with one lesion were suitable for final OCT analysis five years after DES implantation. The analytical approach was based on a hierarchical Bayesian random-effects model and compared strut coverage, protrusion and malapposition between ACS and stable CAD patients. The analysis was adjusted for differences in baseline patient characteristics (hypertension, hyperlipidemia, left ventricular function) and stent type. Results: OCT analysis was performed in 53 ACS culprit lesions with 7,864 struts, and in 35 stable lesions with 5’298 struts. A total of 284 (1.73%) struts were uncovered in ACS culprit lesions compared to 97 struts (0.7%) in stable lesions, (adjusted p=0.041). Malapposed struts were present in 303 (1.33%) of ACS culprit lesions as compared with 106 (0.45%) of stable lesions (adjusted p=0.072). Protruding struts were more frequent among ACS culprit lesions 106 (0.50%) than stable lesions 0.34 (0.13%), (adjusted p=0.038). Conclusion: Uncovered, malapposed and protruding struts are more frequent in culprit lesions of ACS patients compared with lesions of stable CAD patients 5 years after implantation of early generation DES. These findings suggest a differential healing response of ACS compared with stable CAD patients.
JACC Vol 58/20/Suppl B | November 7-11, 2011 | TCT Abstracts/POSTER/Intravascular Imaging: IVUS, OCT, Spectroscopy, and Other