Abstract 13165: Frequency-Domain Optical Coherence Tomography Assessment of In-stent Restenosis After Percutaneous Coronary Intervention With Two-Stent Technique in Unprotected Left Main
Aim: FD-OCT has contributed to a better understanding of ISR; however, studies evaluating vascular response to stents and ISR pattern after two-stent technique in ULM are lacking. We aim to evaluate the ISR pattern of proximal LAD and LCX after two-stent technique in ULM.
Methods: We performed FD-OCT in 26 patients with isolated or combined ISR (identified by angiography as >50% diameter stenosis) after DES implantation in proximal LCX and LAD after two-stent techniques. Four patients had LAD-, 13 patients had LCX- and 9 patients had both LAD and LCX-ISR. In total, 13 ISR lesions of LAD and 22 of LCX underwent FD-OCT assessments. Strut- and cross-sectional level analyses were undertaken in proximal segments of LAD and LCX (5mm distal to ostium). In addition, we compared OCT findings in the flow divider (FD) and in the lateral wall (LW) sides.
Results: The follow-up time (days) was 386.9±426.3. In both LAD and LCX, the distance from the ostium to minimum lumen area (MLA; LAD, 2.00mm [1.00, 3.00]; LCX, 1.00mm [0.00, 1.80] distal to ostium), as well as to minimum stent area (MSA; LAD, 1.00mm [0.00, 2.00]; LCX 1.00mm [0.00, 2.00]) sites were short. Uncovered struts were more common at FD compared with LW in LAD (6.25% [0.00, 20.00] vs. 0.00% [0.00, 0.00], respectively, p=0.016) and LCX (11.32% [0.00, 19.44] vs. 0.00% [0.00, 4.55], respectively, p<0.001). Conversely, neointimal hyperplasia (NIH) was significantly thicker at FD compared with LW in LCX (0.31mm [0.19, 0.47] vs. 0.15mm [0.09, 0.31], p<0.001), whereas no significant difference was identified in LAD.
Figure 1 shows the uncovered stent struts with thrombus and thicker NIH in FD of LCX.
Conclusions: The most exacerbated NIH proliferation site in ULM bifurcation after DES implantation using two-stent techniques is located close to the ostium of LCX and LAD. While uncovered struts were more commonly found in FD of both arteries, NIH was significantly ticker in FD compared with LW in LCX and comparable between them in LAD.
Author Disclosures: Y. Fujino: None. G. Attizzani: None. S. Tahara: None. K. Takagi: None. T. Naganuma: None. K. Fukino: None. H. Ishiguro: None. H. Bezerra: None. M. Costa: None. S. Nakamura: None.
- © 2014 by American Heart Association, Inc.