Comparison of Vascular Response After Sirolimus-Eluting Stent Implantation Between Patients With Unstable and Stable Angina PectorisA Serial Optical Coherence Tomography Study
Takashi Kubo, MD, PhD,
Toshio Imanishi, MD, PhD,
Hironori Kitabata, MD,
Akio Kuroi, MD,
Satoshi Ueno, MD,
Takashi Yamano, MD,
Takashi Tanimoto, MD,
Yoshiki Matsuo, MD, PhD,
Takashi Masho, MD,
Shigeho Takarada, MD, PhD,
Atsushi Tanaka, MD, PhD,
Nobuo Nakamura, MD,
Masato Mizukoshi, MD, PhD,
Yoshiaki Tomobuchi, MD, PhD,
Takashi Akasaka, MD, PhD*
Department of Cardiovascular Medicine, Wakayama Medical University, Wakayama, Japan.
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Figure 1 Representative OCT Images of Stented Lesions After PCI and Corresponding IVUS Images
(A-1) OCT-visualized inadequate stent strut apposition (arrows). (A-2) It was not shown clearly on IVUS. (B-1) Tissue protrusion between stent struts was observed in OCT image (arrow). (B-2) It was not evident in the IVUS image. (C-1) Intracoronary thrombi were identified as intraluminal mass images with signal-free shadow by OCT (arrows). (C-2) They were not detected by IVUS. (D-1) Coronary dissection at the site of stent edge was demonstrated by OCT (arrows). (D-2) IVUS documented dissection (5 o'clock) and clot (2 o'clock). IVUS = intravascular ultrasound; OCT = optical coherence tomography; PCI = percutaneous coronary intervention.
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Figure 2 Representative OCT Images of SES at 9 Months' Follow-Up
(A-1, A-2) OCT-visualized stent struts and neointimal hyperplasia clearly. (B-1) Each stent strut was classified into one of the three categories. (B-2) The strut was well-apposed to vessel wall and covered by neointima. (B-3) The struts were well-apposed to vessel wall and not covered by neointima. (B-4) The struts were inadequately apposed to vessel wall and not covered by neointima. OCT = optical coherence tomography; SES = sirolimus-eluting stent.
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Figure 3 Serial OCT Images of the Culprit Lesion in UAP Before PCI, After PCI, and at 9 Months' Follow-Up
(A) OCT demonstrated the lipid-core (LC) with calcium (Ca) before PCI. Fibrous cap was disrupted (arrow) at the tiniest part (30 µm). (B) The plaque was ruptured by PCI (*). Stent struts were not well-apposed to the core cavity and vessel wall. Intracoronary thrombus was observed (9 o'clock). (C) At 9 months' follow-up, OCT showed persistence of core cavity (**) and inadequately-apposed stent struts without neointimal coverage. OCT = optical coherence tomography; PCI = percutaneous coronary intervention; UAP = unstable angina pectoris.
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Figure 4 OCT and IVUS Findings After PCI in UAP and SAP Patients
(A) In the OCT analysis, although the incidence of stent edge dissection was not different between UAP and SAP, the incidence of inadequate stent apposition (*p = 0.038), tissue protrusion ( p = 0.005) and intracoronary thrombus ( p < 0.001) in UAP was significantly higher than that in SAP. (B) In the IVUS analysis, the incidence of inadequate lesion findings after stenting was similar in both groups. IVUS = intravascular ultrasound; OCT = optical coherence tomography; PCI = percutaneous coronary intervention; SAP = stable angina pectoris; UAP = unstable angina pectoris.
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Figure 5 Incidence of the Ruptured Plaque Assessed With OCT Before and After PCI and at 9 Months' Follow-Up in UAP and SAP Patients
Ruptured plaque in UAP was increased by PCI (*p < 0.05), and decreased during 9 months' follow-up (p < 0.005). In SAP, it was not changed after PCI and during follow-up. The incidence of the ruptured plaque was significantly greater in UAP than that in SAP before and after PCI and 9 months' follow-up (p < 0.05).
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Figure 6 Changes of the Lesion Findings Before and After PCI to 9 Months After Sirolimus-Eluting Stent Implantation in Unstable Plaque and Stable Plaque
(A) The ruptured plaque has a core cavity, and the thick-cap fibroatheroma was ruptured by PCI. At the site of the plaque cavity, the stent struts were not well-apposed to the vessel wall. Furthermore, tissue protrusion and intracoronary thrombus were observed after PCI. At 9 months' follow-up, the ruptured plaque cavity was persistent, and the inadequately-apposed stent struts were not covered by neointima. (B) The thick-cap fibroatheroma was not ruptured during PCI. The stent struts were well-apposed to vessel wall after PCI, and covered by neointima at 9 months' follow-up. Figure illustrations done by Rob Flewell. PCI = percutaneous coronary intervention.
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