Comparison of serial optical coherence tomography imaging following aggressive stent expansion technique: insight from t
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ORIGINAL PAPER
Comparison of serial optical coherence tomography imaging following aggressive stent expansion technique: insight from the MECHANISM study Wataru Sasaki1 · Masaru Ishida1 · Tomonori Itoh1 · Yohei Uchimura1 · Hideto Oda1 · Yuya Taguchi1 · Kyosuke Kaneko1 · Tsubasa Sakamoto1 · Iwao Goto1 · Masafumi Sakuma1 · Daisuke Terashita2,3 · Hiromasa Otake3 · Toshiro Shinke3,4 · Yoshihiro Morino1 Received: 3 August 2020 / Accepted: 26 September 2020 © Springer Nature B.V. 2020
Abstract To compare early vascular healing following cobalt-chromium everolimus-eluting stent (CoCr-EES) implantation between groups with or without aggressive stent expansion in patients treated by CoCr-EES for stable coronary artery disease (CAD). Seventy-one stable CAD lesions underwent CoCr-EES implantation and analysis of serial optical coherence tomography (OCT) images obtained post-procedure and at early-term (1- or 3-month) follow-up. The endpoints of this study were neointimal thickness at the time of 1- or 3-month OCT and presence and healing of stent edge dissection. Aggressive stent expansion was defined as a lesion complying with ILUMIEN III sizing protocol; that is, external elastic lamina (EEL) diameter minus maximum balloon diameter ≤ 0.25 mm. Comparing groups with and without aggressive stent expansion, median neointimal thickness at 1 and 3 months after CoCr-EES implantation was similar (1 month: 0.031 mm vs. 0.041 mm, respectively, p = 0.27; 3 months: 0.036 mm vs. 0.040 mm, respectively, p = 0.84). Regarding stent edge findings, the presence of any stent edge dissection immediately after percutaneous coronary intervention was also similar between the groups (25% vs. 15%, respectively; p = 0.30) and most stent edge dissections resolved completely within 3 months, regardless of location or dissection severity. After 1 year, no clinically driven target lesion revascularization or stent thrombosis was observed in either cohort. Even after aggressive stent expansion, early neointimal proliferation appeared modest with CoCrEES implantation, and most stent edge dissections had resolved by 3 months. These findings may support the feasibility of EEL-based sizing by pre-stenting OCT. Keywords Coronary artery disease · Drug-eluting stent · Optical coherence tomography · Percutaneous coronary intervention
Introduction At the time of coronary stent implantation, the physician sometimes performs aggressive expansion to avoid stent under-expansion, which is related to worse clinical outcomes that include in-stent restenosis, target lesion * Masaru Ishida maishida@iwate‑med.ac.jp 1
Iwate Medical University, 2‑1‑1 Idaidori, Shiwa‑gun, Yahaba‑cho, Iwate 028‑3695, Japan
2
Kita-Harima Medical Center, Ono, Japan
3
Kobe University Graduate School of Medicine, Kobe, Japan
4
Showa University School of Medicine, Tokyo, Japan
revascularization, and/or stent thrombosis [1, 2]. Importantly, because overstretch and mechanical injury to the coronary artery lead to vessel healing of mechanical and traumatic damage caused by sten
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