Intravascular Ultrasound Assessment of the Incidence and Predictors of Edge Dissections After Drug-Eluting Stent Implantation
Xuebo Liu, MD,
Kenichi Tsujita, MD, PhD,
Akiko Maehara, MD*,
Gary S. Mintz, MD,
Giora Weisz, MD,
George D. Dangas, MD, PhD,
Alexandra J. Lansky, MD,
Edward M. Kreps, MD,
LeRoy E. Rabbani, MD,
Michael Collins, MD,
Gregg W. Stone, MD,
Jeffrey W. Moses, MD,
Roxana Mehran, MD,
Martin B. Leon, MD
Columbia University Medical Center and Cardiovascular Research Foundation, New York, New York
* Reprint requests and correspondence: Dr. Akiko Maehara, Cardiovascular Research Foundation, 111 East 59th Street, 12th Floor, New York, New York 10022 (Email: amaehara{at}crf.org).
Objectives: We used intravascular ultrasound (IVUS) to assess incidence, predictors, morphology, and angiographic findings of edge dissections after drug-eluting stent (DES) implantation.
Background: DES implantation strategies differ compared with bare-metal stenting; coronary dissections after DES implantation have not been well studied.
Methods: We studied 887 patients with 1,045 non–in-stent restenosis lesions in 977 native arteries undergoing DES implantation with IVUS imaging.
Results: Eighty-two dissections were detected; 51.2% (42 of 82) involved the proximal and 48.8% (40 of 82) the distal stent edge. Residual plaque area (8.0 ± 4.3 mm2 vs. 5.2 ± 3.0 mm2, p < 0.0001); plaque burden (52.2 ± 11.7% vs. 36.2 ± 15.3%, p < 0.0001); plaque eccentricity (8.4 ± 5.5 vs. 4.0 ± 3.4, p < 0.0001); and stent edge symmetry (1.2 ± 0.1 vs. 1.1 ± 0.1, p = 0.02) were larger; plaque burden  50% was more frequent (62.0% vs. 17.2%, p < 0.0001); calcium deposits (52.1% vs. 35.2%, p = 0.03) more common; and lumen-to-stent-edge-area ratio (0.9 ± 0.2 vs. 1.0 ± 0.2, p < 0.0001) was smaller in the edge dissection group compared with the nondissection group. Intramural hematomas occurred in 34.1% (28 of 82) of dissections. When compared with nonhematoma dissections, residual plaque and media area (6.4 ± 2.5 mm2 vs. 8.9 ± 4.6 mm2, p = 0.04) was smaller, and stent edges less asymmetric (1.1 ± 0.1 vs. 1.2 ± 0.1, p = 0.009) in the dissection with hematoma group. Independent predictors of any stent edge dissection were residual plaque eccentricity (odds ratio [OR]: 1.4, p = 0.02), lumen-to-stent-edge-area ratio (OR: 0.0, p = 0.007), and stent edge symmetry (OR: 1.2, p = 0.02 for each 0.01 increase).
Conclusions: IVUS identified edge dissections after 9.2% of DES implantations. Residual plaque eccentricity, lumen-to-stent-edge-area ratio, and stent edge symmetry predicted coronary stent edge dissections. Dissections in less diseased reference segments more often evolved into an intramural hematoma.
Key Words: drug-eluting stent • intravascular ultrasound • edge dissection • intramural hematoma
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Abbreviations and Acronyms
| | BMS = bare-metal stent(s) | | CI = confidence interval | | CSA = cross-sectional area | | DES = drug-eluting stent(s) | | EEM = external elastic membrane | | IVUS = intravascular ultrasound | | OR = odds ratio | | P and M = plaque and media | | PES = paclitaxel-eluting stent(s) | | SES = sirolimus-eluting stent(s) |
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