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Published on: September 14, 2009
Impact of 12-Month Angioscopic Thrombi and Yellow Plaque After Drug-Eluting Stent Implantation
Masami Nishino1, Yasuyuki Egami1, Hiroaki Nohara1
1Division of Cardiology, Osaka Rosai Hospital.
Insights
Polymer-free stents may stabilize plaque vulnerability, while diabetes management, stent area, and coverage impact intrastent thrombogenicity after coronary stent implantation.
Area of Science:
- Cardiovascular Interventions
- Medical Device Technology
- Intravascular Imaging
Background:
- Coronary angioscopy (CAS) offers unique visualization of thrombi and plaque color.
- Serial CAS findings after drug-eluting stent (DES) implantation require further elucidation.
- This study compares polymer-free biolimus A9-coated stents (PF-BCS) with durable polymer everolimus-eluting stents (DP-EES).
Purpose of the Study:
- To investigate serial CAS and OCT findings after PF-BCS and DP-EES implantation.
- To identify factors associated with angioscopic thrombi and yellow plaque.
- To assess the clinical impact of thrombi and yellow plaque at 12 months.
Main Methods:
- Serial CAS and OCT imaging at 1 and 12 months in 99 patients.
- Evaluation of factors correlating with angioscopic thrombi and yellow plaque.
- Analysis of the clinical impact of thrombi and yellow plaque (BTY) at 12 months.
Main Results:
- Thrombi and yellow plaque incidence/grade decreased from 1 to 12 months.
- No new thrombi appeared at 12 months; 2 DP-EES patients developed new yellow plaque.
- HbA1c, minimum stent area, and strut coverage correlated with thrombi; DP-EES correlated with yellow plaque.
- The BTY group (17%) showed no correlation with clinical events.
Conclusions:
- Diabetes management, stent area, and adequate stent coverage are crucial for intrastent thrombogenicity.
- Polymer-free stents demonstrate utility in stabilizing plaque vulnerability.
Background:
Coronary angioscopy (CAS) has 2 unique abilities: direct visualization of thrombi and plaque color. However, in the recent drug-eluting stent (DES) era, serial CAS findings after DES implantation have not been fully elucidated. We investigated the impact of CAS findings after implantation of a polymer-free biolimus A9-coated stent (PF-BCS) or durable polymer everolimus-eluting stent (DP-EES).
Methods And Results:
We investigated serial CAS and optical coherence tomography (OCT) findings at 1 and 12 months in 99 patients who underwent PF-BCS or DP-EES implantation. We evaluated factors correlated with angioscopic thrombi and yellow plaque, and the clinical impact of both thrombi and yellow plaque at 12 months (BTY). The BTY group included 17 (22%) patients. The incidence and grade of thrombi and yellow plaque decreased from 1 to 12 months. Although no patients had newly appearing thrombi at 12 months, 2 DP-EES patients had newly appearing yellow plaque at 12 months. Multivariable analysis revealed HbA1c, minimum stent area, and adequate strut coverage were significant factors correlated with 12-month angioscopic thrombi, and DP-EESs were significantly correlated with 12-month yellow plaque. However, BTY was not correlated with clinical events.
Conclusions:
The management of diabetes, stent area, and adequate stent coverage are important for intrastent thrombogenicity and polymer-free stents are useful for stabilizing plaque vulnerability.
