Abstract
Background
Incomplete stent apposition (ISA) is related to stent thrombosis, which is a serious adverse event. We aim to assess the time-course of ISA after 2nd generation everolimus-eluting stent (EES) implantation.
Methods
In HEAL-EES study, we enrolled 36 patients who underwent percutaneous coronary intervention (PCI) with EES. OCT imaging was performed at baseline and follow-up. Patients were randomized 1:1:1 into 3 groups according to the time in which follow-up was performed: group A (6-month), group B (9-month), and group C (12-month). In this subanalysis, patients who had ISA segments at baseline and/or follow-up OCT were analyzed.
Result
At baseline, among 41 lesions in 36 patients, 20 lesions in 18 patients had ISA segments and were analyzed. At baseline, there were 3.0% ISA struts in group A (n = 8), 2.8% in group B (n = 4), and 4.5% in group C (n = 8). At follow-up, ISA struts were present in 0.09%, 0.16% and 0.64%; respectively in groups A, B, and C. At follow-up, there was a significant decrease in the frequency of ISA: group A 3.0% vs. 0.09% ( p < 0.001), group B 2.8% vs. 0.16% ( p < 0.001), and group C 4.5% vs. 0.64% ( p < 0.001). In group A, there was one late acquired ISA at follow-up.
Conclusions
In patients undergoing 2nd generation EES implantation, area of acute ISA assessed by OCT, was almost resolved at 6-month follow-up.
Highlights
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Time-course of incomplete stent apposition of everolimus-eluting stent was assessed.
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Serial optical coherence tomography images at baseline and follow-up were evaluated.
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Acute incomplete stent apposition was almost resolved as early as at 6 months.
1
Introduction
Presence of incomplete stent apposition (ISA) is related to delayed neointimal coverage of stent struts and to late or very late stent thrombosis , which is associated with poor outcome. ISA at follow-up is defined as persistent ISA or late-acquired ISA (LAISA) that appeared to be relevant with the advent of DES . Previous studies showed that 2nd generation DES has less frequency of uncovered struts than 1st generation DES at optical coherence tomography (OCT) follow-up . It has also been showed that everolimus-eluting stent (EES) has lower risk of very late stent thrombosis than 1st generation DES .
For the prevention of stent thrombosis, the optimal duration of dual antiplatelet therapy (DAPT) in 2nd generation DES has been investigated . A recent meta-analysis of randomized study suggests that the risk/benefit ratio for extending DAPT has an important variation according to type of DES used . So the risk/benefit ratio of DAPT duration may vary according to the different time-course of ISA. Therefore, it is important to evaluate the time-course of ISA of EES for the decision to shorten DAPT. There are few data supported by OCT or pathological data about it.
OCT image is an intracoronary imaging modality with a high resolution of approximately 10–20 μm, which enables detailed assessment of stent apposition and tissue coverage .
In this study, we evaluate the time-course of acute ISA of EES by using OCT in different time of follow-up after stent implantation.
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