Abstract 11192: Qualitative OCT Assessment in Late Catch-up Lesions After DES Implantations
Background: The pathophysiology of late catch-up after drug-eluting stent (DES) implantation remains unknown.
Methods: To address this issue, we examined patients who underwent follow-up coronary angiography (CAG) twice after DES implantation. The first (early) scheduled CAG was performed at six to nine months after percutaneous coronary intervention (PCI) and the second (late) at 18 to 24 months after PCI. All lesions with target lesion revascularization at first follow up were excluded. Late catch-up was defined as lesions that progressed from less than 50% diameter stenosis (DS) at the first CAG to more than 50% DS at the second CAG. Lesions with the late catch-up and more than 50% DS were divided into two groups, group R: lesions with rapid progression (from less than 25% DS at the first CAG to more than 50% DS at the second CAG) and group G: lesions with gradual progression (from 25-50% DS at the first CAG to more than 50% DS at the second CAG). Optical coherence tomography (OCT) was performed at the second angiography for all late catch-up lesions.
Results: We indentified 805 lesions in 782 patients who underwent Cypher and Taxus stent implantation between April 2008 and Jan. 2010. Early in-stent restenosis (ISR) rate and late ISR rate were 7.8% (50 of 636 lesions) and 6.6% (27 of 408 lesions), respectively (p=NS). Late ISR rate in lesions with less than 25% DS and in those with 25 to 50% DS at the first CAG were 3.2% and 17.5%, respectively (p=0.003). In the qualitative OCT assessment of late ISR lesions, each ratio of homogeneous, layered, heterogeneous and lipid-laden tissue morphologies in group R and group G were 11% and 27%, 11% and 28%, 22% and 34%, 56% and 11% (p<0.01), respectively.
Conclusions: Late catch-up more frequently occurred in lesions with mild stenosis than in those with less than 25% stenosis at early follow-up angiography. Lipid-laden tissue morphology by OCT was more frequently found in lesions with the rapid progression. These findings suggest that neoatherosclerosis may be important mechanism of the late catch-up after DES implantations in the rapid progression, while neointimal hyperplasia may be important mechanism in the gradual progression.
- © 2012 by American Heart Association, Inc.