Abstract 12254: Assessment of Tissue Characteristics of In-stent Restenosis Lesions for Prediction of Target Lesion Revascularization Following Repeat Percutaneous Coronary Intervention: Insights from the Optical Coherence Tomography Analysis
Objectives Coronary optical coherence tomography (OCT) can depict variable tissue characteristics following in-stent restenosis (ISR). In this study, we aimed to investigate the relationship between ISR tissue characteristics and target lesion revascularization (TLR) after percutaneous coronary intervention (PCI) for ISR.
Methods We enrolled 50 patients (54 coronary lesions) who underwent PCI for ISR, which included 25 lesions of drug-eluting stent (DES)-ISR. The PCI strategy depended on the operator's discretion and DES implantation was performed for 38 (70%) lesions. All patients underwent OCT prior to PCI. OCT images were obtained using a time-domain OCT imaging system and were acquired during the automatic-pull back function (1 mm/s; 20 frames/s). Tissue characteristics were qualitatively and quantitatively assessed using the frame showing maximal lumen narrowing (minimal lumen area). Quantitative OCT signal analysis was performed by a dedicated, semi-automated software.
Results Clinically driven TLR was performed for 9 (17%) lesions and the average observational period was 605 ± 323 (range, 22-1157) days. Six lesions showed the coexistence of eccentric tissue proliferation and strong early signal attenuation (ESA; Figure), which revealed significantly higher cumulative incidence of TLR after PCI for ISR (Graph). DES implantation for ISR had been performed for 5 (83%) ESA lesions. Hemodialysis (83% vs. 21%, p = 0.0047) and DES-ISR (100% vs. 40%, p = 0.0069) were significantly more frequent in ESA lesions than in others. ESA was the predictor of TLR independent of other clinical factors and showed higher root mean square error and signal attenuation in quantitative OCT signal analysis (Table).
Conclusion The present study revealed that ESA on OCT images of ISR is commonly observed in hemodialysis patients and is an independent risk factor for TLR after PCI for DES-ISR. Tissue characterization OCT analysis may be useful for predicting repetitive ISR.
- © 2012 by American Heart Association, Inc.