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ȣ - 500313 167 |
A Virtual Histology Analysis of Plaque Shift after Drug-eluting Stent Implantation |
중앙대학교병원¹ , Washington Hospital Center² , Cardiovascular Research Foundation.NY³ |
김상욱¹, Gary S. Mintz³ , Patrick Ohlmann² , 홍영준² , Salah-Eddine Hassani² , Rajbabu Pakala² , Aleksandra Michalek² , 박경숙,MPH¹ , Augusto D. Pichard² , Lowell F. Satler² , Kenneth M. Kent² , William O. Suddath² , Ron Waksman² , Neil J. Weissman² |
We used Virtual Histology(VH) intravascular ultrasound(IVUS) to evaluate plaque shift that occurs during stent implantation. 27 pts(30 lesions) were amenable to VH analysis before and after drug-eluting stent (DES) implantation. Standard IVUS measures were performed every 1mm within the lesion, stent, and stent edges. We divided the stented lesion and its reference into 7 segments including proximal and distal edge and compared pre-intervention vs post-DES VH-IVUS (absolute amounts of fibrous, fibrofatty, dense calcium, and necrotic core). We excluded the stent strut and its artifact since these have not been validated for VH IVUS analysis. Results. Pt age was 62±12yrs, 60% were males, and 17% were diabetic. Plaque areas increased at the proximal and distal stent edge after DES implantation: 7.32±3.75mm2 to 9.64±4.35mm2 (p<0.001) at the proximal edge and 5.32±3.65mm2 to 8.10±3.96mm2 (p<0.0001) at the distal edge. As shown in the Table, there was a consistent increase in necrotic core area at the proximal and distal edges and/or reference segments (p=0.423 and p=0.01, respectively), but no consistent change in other plaque components. Only fibro-fatty plaque area was decreased within the length of the stent. Conclusion: Stent implantation is associated with redistribution (extrusion) of the necrotic core out of the stent proximally and distally. This may impact on acute complications – i.e., CK elevation - and long-term coronary events – i.e., edge restenosis and myocardial infarction.
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Fibrous
area (mm2) |
Fibro-fatty
area (mm2) |
Dense
calcium area (mm2) |
Necrotic
core area (mm2) |
|
Pre |
Post |
Pre |
Post |
Pre |
Post |
Pre |
Post |
Proximal
ref. |
1.90±1.83 |
2.65±2.14**
|
0.67±0.89 |
0.69±0.76 |
0.19±0.32 |
0.26±0.33 |
0.43±0.42 |
0.62±0.61* |
Proximal
edge |
2.49±2.24 |
2.79±2.20 |
0.73±0.70 |
0.66±0.77 |
0.24±0.36 |
0.21±0.41 |
0.57±0.48 |
0.64±0.61 |
Proximal
stent |
3.09±2.31 |
2.28±1.52** |
1.02±1.10 |
0.49±0.49** |
0.30±0.37 |
0.35±0.51 |
0.77±0.65 |
0.77±0.71 |
Mid-stent |
2.65±2.05 |
2.52±1.87 |
0.99±1.39 |
0.50±0.54* |
0.28±0.39 |
0.25±0.28 |
0.77±0.95 |
0.79±0.68 |
Distal
stent |
2.15±1.72 |
2.09±1.81 |
0.74±1.08 |
0.35±0.48* |
0.21±0.30 |
0.23±0.27 |
0.56±0.70 |
0.70±0.72 |
Distal
edge |
1.54±2.02 |
1.62±1.67 |
0.48±0.75 |
0.32±0.53* |
0.13±0.17 |
0.11±0.17 |
0.31±0.38 |
0.49±0.54** |
Distal
refer. |
1.44±2.08 |
1.54±2.22 |
0.56±0.99 |
0.40±0.88* |
0.10±0.16 |
0.17±0.43 |
0.29±0.39 |
0.76±1.85 |
**
P<0.01,
*P<0.05
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