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In search for "healthy" landing zones for coronary stent placement: are the largest intrasegmental lumens adequate?
Igor Kranjec1, Matjaž Klemenc2, Dinko Zavrl Dzananovic1
1Department of Cardiology, University Medical Center, Ljubljana, Slovenia.
Insights
Reference segments (RSs) for stent placement are often not ideal. Optical coherence tomography (OCT) revealed that healthy landing zones are rare, and thin-cap fibroatheromas (TCFA) in RSs can lead to flow issues.
Area of Science:
- Cardiovascular Imaging
- Interventional Cardiology
- Biomedical Engineering
Background:
- Coronary lesions require stenting within proximal and distal reference segments (RSs).
- Identifying suitable "landing zones" is crucial for effective stent implantation.
- The study investigated the conformity of RSs to the concept of healthy landing zones using optical coherence tomography (OCT).
Purpose of the Study:
- To evaluate the characteristics of reference segments (RSs) used for stent implantation.
- To determine the prevalence of healthy vessel walls and suitable lumen sizes in RSs.
- To assess the impact of tissue composition in RSs on stenting outcomes.
Main Methods:
- Sixty-seven patients undergoing stenting for acute myocardial infarction or stable angina were studied.
- Optical coherence tomography (OCT) was used to analyze reference segments (RSs) and minimal lumens.
- Tissue composition, including thin-cap fibroatheromas (TCFA), was assessed in RSs.
Main Results:
- Healthy vessel walls were infrequent (~10%) at RSs.
- Thin-cap fibroatheromas (TCFA) were more prevalent in acute myocardial infarction patients (29% vs. 9%).
- TCFA extending into proximal RSs correlated with post-stenting flow deterioration (P=0.008).
Conclusions:
- Optimal stent landing zones may require searching beyond traditional reference segments.
- While large lumens in RSs may not cause immediate harm, avoiding TCFA is critical.
- TCFA in landing zones should be avoided to prevent adverse outcomes.
Background:
Coronary lesions are supposed to be enclosed between proximal and distal reference segments (RSs), the sites with the largest lumens within the same vessel segment. Finding "healthy" landing zones has been fundamental for efficient stent implantation. Consequently, our study aimed to determine, using optical coherence tomography (OCT), to what degree RSs conform to this concept.
Methods:
Sixty-seven patients with a mean age of 63.5 years underwent culprit lesion stenting due to acute myocardial infarction (MI) (Group 1) or stable angina (Group 2). OCT was performed with commercially available equipment; all evaluations were made at RSs and minimal lumens.
Results:
Normal vessel wall was infrequent (~10%) at RSs. Acceptable external elastic 220°) occurred in 55% to 67% and in 28% to 31% of RSs, respectively. Tissue composition at RSs was similar in both study groups except for a greater accumulation of thin-cap fibroatheromas (TCFA) in acute MI (29% in Group 1 vs. 9% in Group 2, P=0.035). Flow deterioration after stenting was associated with TCFA clusters extending from culprit main bodies into proximal RSs (P=0.008).
Conclusions:
Optimal landing zones for stent placement should frequently be searched for beyond the culprit lesion segments although utilizing the largest intrasegmental lumens does not seem to cause immediate harm. However, TCFA at the landings should definitely be avoided.
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