Author + information
- Received April 1, 2016
- Accepted May 5, 2016
- Published online July 25, 2016.
- Fuyu Qiu, MDa,b,c,
- Gary S. Mintz, MDa,
- Bernhard Witzenbichler, MDd,
- D. Christopher Metzger, MDe,
- Michael J. Rinaldi, MDf,
- Peter L. Duffy, MD, MMMg,
- Giora Weisz, MDa,b,h,
- Thomas D. Stuckey, MDi,
- Bruce R. Brodie, MDi,
- Rupa Parvataneni, MSa,
- Ajay J. Kirtane, MD, SMa,b,
- Gregg W. Stone, MDa,b and
- Akiko Maehara, MDa,b,∗ ()
- aCardiovascular Research Foundation, New York, New York
- bColumbia University Medical Center, New York-Presbyterian Hospital, New York, New York
- cSir Run Run Shaw Hospital, Zhejiang University School of Medicine, Hangzhou, China
- dHelios Amper-Klinikum, Dachau, Germany
- eWellmont CVA Heart Institute, Kingsport, Tennessee
- fSanger Heart & Vascular Institute/Carolinas HealthCare System, Charlotte, North Carolina
- gReid Heart Center, FirstHealth of the Carolinas, Pinehurst, North Carolina
- hShaare Zedek Medical Center, Jerusalem, Israel
- iLeBauer Cardiovascular Research Foundation/Cone Health, Greensboro, North Carolina
- ↵∗Reprint requests and correspondence:
Dr. Akiko Maehara, Columbia University Medical Center/Cardiovascular Research Foundation, 1700 Broadway, 9th Floor, New York, New York 10019.
Objectives The aim of this study was to evaluate the prevalence and long-term clinical impact of tissue protrusion (TP) after stent implantation.
Background Stent implantation may be associated with tissue (plaque or thrombus) protrusion, especially in unstable lesions, but its clinical impact is unknown.
Methods ADAPT-DES (Assessment of Dual Antiplatelet Therapy With Drug-Eluting Stents) was a prospective multicenter study of 8,663 patients undergoing percutaneous coronary intervention (PCI) using drug-eluting stents. In a pre-specified intravascular ultrasound (IVUS) substudy, 2,072 patients with 2,446 culprit lesions underwent post-PCI IVUS (among whom some also underwent pre-PCI IVUS) and were classified according to the presence or absence of post-stent TP.
Results After PCI, 34.3% of lesions displayed TP on IVUS. Median maximum TP was 0.7 mm2 (interquartile range: 0.5 to 1.2 mm2) in area and 3.0 mm (interquartile range: 1.4 to 6.7 mm) in length. Patients with TP more often presented with ST-segment elevation myocardial infarction or non–ST-segment elevation myocardial infarction but less often with unstable angina or stable ischemic heart disease. In 893 culprit lesions that were also examined pre-PCI, TP was associated with larger reference luminal area, greater plaque burden, and more plaque ruptures, attenuated plaque, and virtual histology thin-cap fibroatheromas. Because a larger stent or post-dilation balloon was used, post-PCI luminal area was significantly larger in lesions with versus without TP. At 2-year follow-up, there was less clinically driven target lesion revascularization in lesions with TP and no significant difference in major adverse cardiac events (defined as cardiac death, myocardial infarction, or stent thrombosis) in patients with versus without TP.
Conclusions IVUS-detected TP after drug-eluting stent implantation was not associated with worse long-term clinical outcomes, in part because of greater stent expansion in lesions with TP.
Dr. Qiu has received a research grant from Boston Scientific. Dr. Mintz has received grant support from Volcano and is a consultant for Volcano, Boston Scientific, and InfraReDx. Dr. Witzenbichler is a consultant for Volcano; and has received lecture fees from Elixir Medical and Atrium Medical. Dr. Metzger is a consultant for Abbott Vascular, Cordis, IDEV, Medtronic, and Volcano. Dr. Rinaldi is a consultant for Abbott Vascular, Boston Scientific, St. Jude Medical, and Volcano. Dr. Duffy has received speaking honoraria from Volcano. Dr. Weisz is a consultant for InfraReDx. Dr. Stuckey is a member of the advisory board for Boston Scientific; and has received speaking honoraria from Boston Scientific and Eli Lilly/Daiichi-Sankyo. Dr. Kirtane has received institutional research grants to Columbia University from Boston Scientific, Medtronic, Abbott Vascular, Abiomed, St. Jude Medical, Vascular Dynamics, and Eli Lilly. Dr. Maehara has received grant support from Boston Scientific; is a consultant for Boston Scientific and ACIST; and has received speaking fees from St. Jude Medical. All other authors have reported that they have no relationships relevant to the contents of this paper to disclose.
- Received April 1, 2016.
- Accepted May 5, 2016.
- American College of Cardiology Foundation