Serial three-dimensional optical coherence tomography assessment of strut coverage and intraluminal structures after dru
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ORIGINAL ARTICLE
Serial three-dimensional optical coherence tomography assessment of strut coverage and intraluminal structures after drug-eluting stent implantation Takao Maeda • Takayuki Okamura • Jutaro Yamada • Tomoko Nao • Hiroki Tateishi • Masayuki Yoshimura • Takamasa Oda • Kohzoh Shiraishi • Tadamitsu Nakashima • Takeshi Nakamura • Toshiro Miura • Masafumi Yano
Received: 19 June 2013 / Accepted: 4 September 2013 / Published online: 22 September 2013 Ó Japanese Association of Cardiovascular Intervention and Therapeutics 2013
Abstract Understanding of intraluminal structure and distribution of uncovered struts after drug-eluting stent implantation are limited by only 2-dimensional (2D) optical coherence tomography (OCT) images. We compared tissue coverage with 3-dimensional (3D) OCT and 2D quantitative analyses, and changes in intraluminal structure immediately after (baseline) everolimus-eluting stent (EES) implantation and at follow-up. The 2D analyses of uncovered struts ratio and tissue coverage thickness at a 0.5-mm interval were compared to 3D-OCT images and visually classified for the degree of tissue coverage. The difference in tissue coverage at baseline and follow-up after EES implantation was evaluated with tissue coverage scores (TCS) calculated by the 3D-OCT classification (Grade 0–3). 3D-OCT classifications were negatively correlated with uncovered-to-total struts (r = -0.864, P \ 0.001) and positively correlated with tissue coverage thickness (r = 0.905, P \ 0.001). Follow-up TCS was greater than baseline TCS (0.2 ± 0.4 vs. 1.4 ± 0.5, P \ 0.001). Moreover, changes in intraluminal structures and longitudinal distribution of uncovered struts were assessed. Incomplete stent appositions, in-stent dissections, and thrombi were decreased at follow-up, indicating progressive arterial healing. The distribution of uncovered-tototal struts could be assessed by 3D-OCT, which was related to 2D analysis. Significant correlations between 3DOCT classifications and quantitative analyses were shown.
T. Maeda T. Okamura (&) J. Yamada T. Nao H. Tateishi M. Yoshimura T. Oda K. Shiraishi T. Nakashima T. Nakamura T. Miura M. Yano Division of Cardiology, Department of Medicine and Clinical Science, Yamaguchi University Graduate School of Medicine, 1-1-1 Minamikogushi, Ube, Yamaguchi 755-8505, Japan e-mail: [email protected]
The classification and visual assessment of intraluminal structures by 3D-OCT were useful in evaluating arterial healing after EES implantation. Keywords Optical coherence tomography Everolimus-eluting stent Tissue coverage Arterial healing Three-dimensional imaging
Introduction Compared to bare metal stents (BMS), drug-eluting stents (DES) dramatically reduce the incidence of restenosis; the clinical use of DES has therefore become widespread [1]. However, the risk of late stent thrombosis after DES implantation remains a serious concern [2, 3]. Endothelial strut coverage is the most powerful histological predictor of stent thrombosis [4]. The high resolu
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