Abstract 15409: Delayed Arterial Healing After Sirolimus Eluting Stents Implantation Into the Dominant Necrotic Core Lesions in Patients With Stable Coronary Artery Disease
Background: Delayed arterial healing, such as persistent uncovered strut after drug eluting stent (DES) implantation may contribute to late adverse event. We hypothesized that morphology of underlying plaque before intervention may affect the healing response after DES implantation.
Methods: Twenty patients (25 lesions) with stable angina underwent virtual histology intravascular ultrasound (VH-IVUS) before sirolimus-eluting stents (SES) implantation. Plaque characteristics at cross-section with the minimal lumen area were classified into 4 components with VH-IVUS. At 6 months after SES implant, optical coherence tomography (OCT) analysis was made. We defined delayed healing (DH) stents as those which have cross-section with a ratio of uncovered struts to total struts (RUST) of more than 30% and non-delayed healing (non-DH) stents as those without cross-section with RUST of more than 30%. Also, we defined % neointimal coverage as the ratio of covered strut number to total strut number per stent.
Results: 9 stents (36%) were identified as DH group and 16 stents (64%) were non-DH group. VH-IVUS analysis for original plaque character revealed thatthe % necrotic core area were significantly higher and % fibrous area was significantly lower in DH group (35.5±6.64% vs. 14.7±5.19% , P= <0.001, 44.7±11.6mm2 vs. 59.4±6.75mm2 , P=0.0028, respectively). Stent size, length, %plaque burden, and reference vessel area showed no relation with %neointimal coverage. However, significant correlation between % neointimal coverage and %area of necrotic core (r=−0.611, p=0.01) and fibrous (r=0.573, p=0.02) were found. There was also significant negative correlation between % neointimal coverage and serum TC (r=−0.489, p=0.01), LDL-C (r=−0.538, p=0.005), and hsCRP level (r=−0.501, p=0.01).
Conclusion: Higher % necrotic core and lower %fibrous components were related to poor neointimal coverage at 6 months after SES implantation. These data suggest lipid-rich coronary lesions further retard vessel healing post DES implantation.
- © 2010 by American Heart Association, Inc.