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Accuracy of Optical Coherence Tomography in the Evaluation of Neointimal Coverage After Stent Implantation

Akira Murata, MD^_*, David Wallace-Bradley, BS^_*, Armando Tellez, MD^_*, Carlos Alviar, MD^_*, Michael Aboodi, BS^_*, Alexander Sheehy, MS, Leslie Coleman, DVM, MS, Laura Perkins, DVM, PhD, Gaku Nakazawa, MD, Gary Mintz, MD^_*, Greg L. Kaluza, MD, PhD^_*, Renu Virmani, MD, Juan F. Granada, MD^_*,_*

^_* Skirball Center for Cardiovascular Research, Cardiovascular Research Foundation, Orangeburg, New York
Abbott Vascular, Santa Clara, California
CV Path, Gaithersburg, Maryland

^_* Reprint requests and correspondence: Dr. Juan F. Granada, Skirball Center for Cardiovascular Research, Cardiovascular Research Foundation, 8 Corporate Drive, Orangeburg, New York 10962 (Email: jgranada{at}crf.org).

Objectives: This study aimed to evaluate the accuracy of optical coherence tomography (OCT) in analyzing the neointimal response to several drug-eluting stent (DES) types by comparing OCT images acquired in vivo with corresponding histological specimens using a nondiseased porcine injury model.

Background: Optical coherence tomography is emerging as a promising endovascular imaging tool for the evaluation of neointimal response after DES implantation.

Methods: A total of 84 stents were implanted—22 ML Vision (Abbott Vascular, Santa Clara, California), 22 Xience V (Abbott Vascular), 20 Endeavor (Medtronic, Minneapolis, Minnesota), and 20 Taxus Liberté (Boston Scientific, Natick, Massachusetts) stents—in normal porcine coronary arteries and were harvested at 28 (n = 42) and 90 (n = 42) days, with the different stent types equally distributed between the 2 follow-up periods. At termination, morphometric evaluation using OCT imaging was performed in all stented arteries. Histological morphometric analysis was performed and correlated with OCT.

Results: A total of 622 OCT–histology matched frames acquired from all stent designs were analyzed. The luminal (13.7%) and stent (6.1%) areas were consistently larger by OCT compared with histology. The mean neointimal thickness was very similar between techniques (3.27% variation). There was a high correlation between OCT and histology for the evaluation of neointimal area (R² = 0.804), luminal area (R² = 0.825), and neointimal thickness (R² = 0.789). Correlation for total stent area was poor (R² = 0.352). Although the proportion of individual struts determined to be uncovered by OCT and histology was similar, there was significant variation in the estimation of strut coverage between OCT and histology when the neointimal thickness was between 20 and 80 µm. This variation converged for neointimal thicknesses between 80 and 100 µm.

Conclusions: Subtle differences in neointimal formation induced by current DES can be reproducibly analyzed in vivo by OCT. However, OCT measurement of stent area seems to have less correlation with histology.

Key Words: optical coherence tomography • imaging validation • drug-eluting stent

Abbreviations and Acronyms   DES = drug-eluting stent(s)   EEL = external elastic lamina   IEL = internal elastic lamina   LAD = left anterior descending   LCX = left circumflex   OCT = optical coherence tomography   QCA = quantitative coronary angiography   RCA = right coronary artery

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