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
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Figure 1 Stent Edge Dissection
Post-stenting, angiography showed a normal appearance at the proximal stent edge (arrows indicate dissection site on the pre- and post-stent angiograms). However, intravascular ultrasound demonstrated stent edge dissection. (A) Minimum luminal site before stenting. (B) The site of proximal stent edge before stenting. (C) Proximal stent edge; stent cross-sectional area measured 6.6 mm2 with stent symmetry of 1.3. (D) Stent edge dissection with an arc of approximately 90°, but no lumen compromise.
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Figure 2 Intramural Hematoma With Contrast Retention
PAngiography showed type B dissection proximal to stent edge in the proximal left anterior descending coronary artery (arrows indicate dissection site on the pre- and post-stent angiograms). Intravascular ultrasound demonstrated an intramural hematoma with contrast retention; cross-sectional intravascular ultrasound images from 1 to 6 showed the hematoma start and stop sites. 1 = The proximal stent edge ended at an eccentric plaque. 2 = The hematoma developed in the arc of normal vessel wall opposite the eccentric plaque; note the thin intimal flap (arrow) adjacent to the intravascular ultrasound catheter. 3 = Smaller hematoma (arrow). 4 = Small echolucent area (arrow) within the hematoma. 5 = Large echolucent area (arrow). 6 = The proximal hematoma stop site.
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Figure 3 Intramural Hematoma Without Contrast Retention
Angiography showed type E dissection proximal to stent edge (arrows indicate dissection site on the pre- and post-stent angiograms) in the mid-right coronary artery. The cross-sectional intravascular ultrasound image showed that the hematoma was stopped by right ventricular (RV) branch. The intravascular ultrasound demonstrated an intramural hematoma without contrast retention. (A) The cross-sectional intravascular ultrasound images before stenting. (B) The cross-sectional intravascular ultrasound images after stent implantation showing a hematoma in sections 2 to 5; individual cross sections correspond to the equivalent sections in A. (C) Longitudinal intravascular ultrasound image after stenting. Long arrow indicates the proximal stent edge and the hematoma start point that extended proximally. The intramural hematoma was 13.1 mm in length. Short arrows indicate the intramural hematoma without contrast retention.
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