open access

Vol 23, No 3 (2016)
INTERVENTIONS Original articles
Published online: 2016-04-07
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Time course of vascular response after an a priori strategy of bare metal stent implantation post-dilated with a paclitaxel-coated balloon: Implementation of a three-dimensional analysis algorithm with optical coherence tomography

Sylvia Otto, Johannes Gassdorf, Kristina Nitsche, Juan Luis Gutiérrez-Chico, Aleh Kryvanos, Björn Goebel, Hans R. Figulla, Tudor C. Poerner
DOI: 10.5603/CJ.a2016.0018
·
Pubmed: 27064798
·
Cardiol J 2016;23(3):296-306.

open access

Vol 23, No 3 (2016)
INTERVENTIONS Original articles
Published online: 2016-04-07

Abstract

Background: An a priori combined therapy of a bare metal stent post-dilated with a paclitaxel- -coated balloon (PCB) was investigated with optical coherence tomography (OCT) at 2 and 6 months regarding vessel response. Previous studies have shown inconsistent results and the time course of vessel healing after such an interventional strategy is unknown.

Methods: Thirty-three de novo lesions in 32 patients were electively treated. Six-month OCT analysis was available in 24 lesions. Two-month OCT follow-up was obtained in 16 lesions. Sequential OCT at 2 and 6 months was available in 7 patients. A novel 3-dimensional picture of vessel segments as spread outs was implemented.

Results: Severe incomplete stent apposition (ISA) accompanied by significantly lower strut coverage were found at 2-month compared with 6-month follow-up (ISA struts: 11.4 ± 11.8% vs. 1.8 ± 4.8%, p = 0.001; uncovered struts: 14.5 ± 14.8% vs. 2.0 ± 5.3%, p = 0.001). ISA size diminished over time and the possibly observed phenomenon of positive vessel remodeling (remodeling volume: 4.9 ± 5.9 mm3 at 2-months vs. 2.0 ± 2.6 mm3 at 6-months; p = 0.042) was largely reversible in most lesions.

Conclusions: Bare metal stenting with adjunctive application of paclitaxel by a coated bal­loon shows transient severe incomplete strut apposition, most likely due to focal positive ves­sel remodeling. Thus, caution is needed in bailout situations following a PCB angioplasty. A novel illustration of OCT parameters as “carpet views” enables a comprehensive analysis of investigated stents.  

Abstract

Background: An a priori combined therapy of a bare metal stent post-dilated with a paclitaxel- -coated balloon (PCB) was investigated with optical coherence tomography (OCT) at 2 and 6 months regarding vessel response. Previous studies have shown inconsistent results and the time course of vessel healing after such an interventional strategy is unknown.

Methods: Thirty-three de novo lesions in 32 patients were electively treated. Six-month OCT analysis was available in 24 lesions. Two-month OCT follow-up was obtained in 16 lesions. Sequential OCT at 2 and 6 months was available in 7 patients. A novel 3-dimensional picture of vessel segments as spread outs was implemented.

Results: Severe incomplete stent apposition (ISA) accompanied by significantly lower strut coverage were found at 2-month compared with 6-month follow-up (ISA struts: 11.4 ± 11.8% vs. 1.8 ± 4.8%, p = 0.001; uncovered struts: 14.5 ± 14.8% vs. 2.0 ± 5.3%, p = 0.001). ISA size diminished over time and the possibly observed phenomenon of positive vessel remodeling (remodeling volume: 4.9 ± 5.9 mm3 at 2-months vs. 2.0 ± 2.6 mm3 at 6-months; p = 0.042) was largely reversible in most lesions.

Conclusions: Bare metal stenting with adjunctive application of paclitaxel by a coated bal­loon shows transient severe incomplete strut apposition, most likely due to focal positive ves­sel remodeling. Thus, caution is needed in bailout situations following a PCB angioplasty. A novel illustration of OCT parameters as “carpet views” enables a comprehensive analysis of investigated stents.  

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Keywords

coronary artery disease, optical coherence tomography, drug-coated balloon, percutaneous coronary intervention

About this article
Title

Time course of vascular response after an a priori strategy of bare metal stent implantation post-dilated with a paclitaxel-coated balloon: Implementation of a three-dimensional analysis algorithm with optical coherence tomography

Journal

Cardiology Journal

Issue

Vol 23, No 3 (2016)

Pages

296-306

Published online

2016-04-07

DOI

10.5603/CJ.a2016.0018

Pubmed

27064798

Bibliographic record

Cardiol J 2016;23(3):296-306.

Keywords

coronary artery disease
optical coherence tomography
drug-coated balloon
percutaneous coronary intervention

Authors

Sylvia Otto
Johannes Gassdorf
Kristina Nitsche
Juan Luis Gutiérrez-Chico
Aleh Kryvanos
Björn Goebel
Hans R. Figulla
Tudor C. Poerner

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