Abstract 11420: Frequency-Domain Optical Coherence Tomography Serial Assessment of Vascular Response After Drug-Eluting Stent Implantation in Unprotected Left Main Coronary Artery
Introduction: Percutaneous coronary intervention (PCI) using drug-eluting stent (DES) in unprotected left main coronary artery (ULM) has been increasingly incorporated in clinical practice. Recently, intravascular frequency-domain optical coherence tomography (FD-OCT) assessments of stent-vessel interactions have been used as surrogates for DES safety; however, no study in ULM is available. Hypothesis: We hypothesized that FD-OCT would be able to provide comprehensive assessments of stent-vessel interactions in ULM.
Methods: We prospectively enrolled 33 consecutive patients with ULM disease treated with sirolimus- (n=11) and everolimus-eluting stents (n=22). FD-OCT assessments were performed post-PCI and at 9-month follow-up and three different segments of ULM were compared: distal (DIS), bifurcation (BIF), and ostial-body (BODY). The primary endpoints were percentage of uncovered and malapposed struts, and the secondary endpoint was neointimal hyperplasia (NIH).
Results: We analyzed 25,873 stent struts. Significant differences were demonstrated for percentage of uncovered struts (3.4%, 11.7%, and 18.7%, respectively for DIS, BIF, and BODY, p<0.05 for all the comparisons). Malapposition was also more common in BODY (5.3%) compared with DIS (0.6%), and BIF (2.0%) segments (p<0.05 for BODY vs. DIS, and BODY vs. BIF). Overall, thin NIH was demonstrated in all segments, though more exacerbated in BIF (0.14 ± 0.16mm) compared with DIS (0.12 ± 0.13mm) and BODY (0.09 ± 0.12mm) segments. Acute malapposition rates led to different patterns of vascular response at 9-month follow-up.
Conclusions: In conclusion, distinct patterns of vascular response after DES implantation were demonstrated in different segments of ULM. While BODY segment showed more uncovered and malapposed struts, BIF segment had more intense NIH proliferation.
- © 2012 by American Heart Association, Inc.