Abstract 17247: Impact of Plaque Shift on Vascular Response in Reference Segments After DES Implantation: A 3D-IVUS Analysis from the J-DESsERT Trial
Background: Previous studies have reported axial redistribution of plaque (plaque shift) into the reference segment during coronary stenting. The aim of this study was to investigate the impact of plaque shift on the vascular response in reference segments after DES implantation as assessed by IVUS.
Methods: Data were derived from the J-DESsERT trial, a prospective, randomized, multi-center study, comparing sirolimus-eluting stents and paclitaxel-eluting stents in de novo native coronary lesions. IVUS was performed at pre-intervention, post-intervention and 8-month follow-up. Volume index (VI: volume/length, mm3/mm) was measured for vessel, lumen, plaque within the 5-mm reference segments adjacent to the stent edge and within the first 5-mm of stented segments. % plaque volume (%PV) was obtained as plaque volume divided by vessel volume. Lesions with significant plaque shift, defined as a >0.5 mm3/mm (10%) increase of plaque VI from pre- to post-intervention, were classified as the shift group.
Results: Among 131 stent edges analyzed, significant plaque shift was detected in 46 stent edges (26 proximal: 20 distal). From post-intervention to follow-up, the shift group showed a significant decrease in vessel VI, lumen VI, and minimum lumen area (MLA, mm2). In contrast, the non-shift group had preserved lumen VI and MLA due to adaptive remodeling against a significant plaque increase during follow-up. In the proximal segment, the degree of step-up/down in lumen VI and %PV from the target to reference segment at pre-intervention positively correlated with the magnitude of plaque shift observed at post-intervention (r=0.42, p<0.01, and r=-0.33, p<0.01, respectively).
Conclusions: In this study, plaque shift into the referent segment caused larger lumen area loss with negative vessel remodeling. This phenomenon might be reduced by avoiding the stent edge positioning at a “shoulder” of the plaque, particularly in the proximal segment.
- © 2012 by American Heart Association, Inc.