Abstract 15332: Different Optical Coherence Tomography Neointimal Tissue Appearance of Drug-Eluting Stent Restenosis After Bifurcation Stenting
Background: Higher incidence of drug-eluting stent (DES) restenosis after bifurcation stenting has been suggested. Delayed healing is another problematic issue associated with bifurcation stenting. We assessed restenotic tissue characteristics after DES deployment at bifurcation using optical coherence tomography (OCT).
Methods and Results: One hundred and fourteen angiographically documented in-stent restenotic lesions of five types of first- and second-generation DES (sirolimus-DES: 50%, paclitaxel-DES: 24%, zotarolimus-DES: 3%, everolimus-DES: 20%, biolimus-DES 3%) in 90 patients were included. OCT appearance of restenotic tissue was qualitatively assessed. Restenotic tissue luminal morphology, such as eccentric, concentric and protruded, was also assessed. Morphometric analysis such as measurement of minimal lumen area (MLA), stent area at MLA, neointimal hyperplasia (NIH) at MLA were performed. All variables were compared between restenotic lesions at bifurcation (BIF) vs. those at non-bifurcation (non-BIF). Among 34 bifurcation lesions (30%), 32 lesions (94%) were related with LMT bifurcation. Restenosis occurred at 730±696 days after initial deployment. Patient and lesion characteristics were similar except more female (38 % vs.16 %, p=0.015) and chronic kidney disease on hemodialysis (35% vs. 14%, p=0.02), and higher incidence of focal stenosis (94% vs. 49%, p<0.001) in BIF vs. non-BIF. OCT tissue appearance, such as homogeneous (64% vs. 76%), attenuated (20% vs. 24%) and heterogeneous (16% vs. 0%) were differently distributed in BIF vs. non-BIF, particularly heterogeneous type was exclusively observed in non-BIF (p=0.04). Protruded tissue morphology tended to be more frequent in BIF vs. non-BIF (12% vs. 1%, p=0.06). Although MLA (2.3±1.2cm2 vs. 1.6±0.8cm2, p=0.003) and stent area at MLA (7.1±2.5cm2 vs. 6.1±1.8cm2, p=0.04) were larger, NIH at MLA (4.8±2.4cm2 vs. 4.5±1.7cm2, p=0.4) were similar in BIF vs. non-BIF.
Conclusions: Different restenotic tissue characteristics were identified by OCT at bifurcation after DES deployment. This may depict a peculiar healing mechanism correlated with DES deployed at bifurcation.
- © 2012 by American Heart Association, Inc.