Abstract 18607: Impact of Procedure-Related Vessel Wall Injury on Coronary Aneurysm Formation After Drug-Eluting Stent Implantation: A Serial Optical Coherence Tomography Study.
Background: Coronary aneurysm (CA) is a known complication after drug-eluting stent (DES) implantation, but its time course and mechanisms remain unknown.We aim to evaluate possible mechanisms and evolution of CA after DES by serial optical coherence tomography (OCT) assessments.
Methods: This is a sub-study of the OCTAXUS trial: a single-center, prospective, open-label trial evaluating serial strut coverage and vessel-wall response of paclitaxel-DES. OCT was performed at baseline, 3 and 9 months. All analyses were performed at an independent core laboratory. OCT qualitative assessment of plaque dissection and protrusion after stenting was performed at an every frame interval (0.06mm) by experts blinded to angiographic data. Co-registration of datasets at different time points was performed. CA was determined by QCA using a definition of >1.5× of the mean reference lumen diameter. We compared the frequency of post-procedure plaque dissection and protrusion at the segment that developed CA vs. segments without CA (non-CA) in the same target lesion. We also compared patients with vs. without CA. A multilevel logistic regression model was applied.
Results: A total of 55 lesions from 29 patients were assessed. Acquired CA was observed in 8 lesions (15%). In 5 lesions that had 2 serial OCT follow-ups available (3, 9 months), 1 CA completely resolved, 3 partially regressed, and 1 was persistent. Protrusion was more frequently observed in CA segments vs. non-CA and patients without CA (66.5% vs. 40.6% and 36.8%, p<0.0001). Dissection with protrusion was also more frequent in CA segments vs. non-CA (5.8% vs. 0.9%, p=NS) without statistical significance.
Conclusion: This is the first longitudinal OCT study suggesting that plaque protrusion and intra-stent dissection detected by OCT may be associated with the mechanism of “early” acquired CA after DES. Metrics of vessel wall injury as assessed by OCT, immediately after stenting, may predict regions at risk of developing CA.
- © 2010 by American Heart Association, Inc.