The influence of strut thickness and cell design on immediate apposition of drug-eluting stents assessed by optical coherence tomography
Section snippets
Patient enrolment and pharmacological treatment
From January 2005, OCT became the mainstay intravascular imaging modality used at our institution to assess results of stent implantation. For this particular study, we only enrolled patients undergoing percutaneous coronary intervention for complex coronary lesions defined as long (> 20 mm), heavily calcified or at a bifurcation. Clinical exclusion criteria were: poor renal function (serum creatinine > 1.5 mg/dL), left ventricular ejection fraction < 30% and haemodynamic instability. Angiographic
Baseline clinical characteristics
Between February 2006 and August 2006, 36 stents implanted in 25 complex lesions from 23 patients were assessed using OCT. Baseline clinical characteristics are shown in Table 2. Mean age of patients was 64.5 ± 10.3 years with 91.3% male. Diabetes mellitus was a risk factor in 17.4% of patients with nearly half of the patients presenting with an acute coronary syndrome.
Angiographic and procedural characteristics
Angiographic and procedural characteristics are shown in Table 3. All lesions were complex (ACC/AHA classification type B or C),
Discussion
This is the first study using OCT to assess stent strut apposition systematically following implantation. Our study has shown that in complex coronary lesions, stent strut malapposition persists despite angiographic optimisation. Further, the thinner struts of the Taxus Liberte stent with its open cell design were more likely to be embedded to the vessel wall compared to the thicker Cypher stent struts employing a closed-cell system. Nevertheless, using high pressure stent expansion with
Conclusions
Despite angiographic optimisation with high pressures and adequately sized balloons, malapposed stent struts are frequently found in complex coronary lesions and more often following the implantation of Cypher Select stents which have a thicker stent strut and closed cell design compared to other DES. With no adverse clinical events at 12 months follow-up, this likely represents a benign phenomenon at least as long as combined anti-platelet therapy is maintained.
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