Evaluation of neointimal coverage in patients with coronary artery aneurysm formation after drug-eluting stent implantation by optical coherence tomography

• Published in: Chinese medical journal 2013-06, Vol.126 (11), p.2092-2097
• Main Authors: Tian, Feng, Chen, Yun-dai, Chen, Lian, Sun, Zhi-jun, Guo, Jun, Jin, Qin-hua, Liu, Chang-fu, Wang, Jin-da, Liu, Hong-bin
• Format: Article
• Language: English
• Subjects: Adult; Aged; Coronary Aneurysm - diagnosis; Drug-Eluting Stents - adverse effects; Humans; Middle Aged; Neointima - diagnosis; Percutaneous Coronary Intervention - adverse effects; Tomography, Optical Coherence - methods; 光学相干; 冠状动脉造影; 动脉瘤; 患者; 支架; 断层扫描; 植入; 膜覆盖
• ISSN: 0366-6999; 2542-5641
• DOI: 10.3760/cma.j.issn.0366-6999.20121485

Background The vessel healing in patients with coronary artery aneurysms （CAA） that form after drug-eluting stent （DES） implantation is not clear. This study aims to assess the vessel healing in patients with CAA formation after DES implanation. Methods From June 2008 to August 2011, follow-up coronary angiography was conducted on 1160 patients who underwent percutaneous coronary intervention （PCI）. The average period of follow-up was about （18.95±13.05） months. A total of 175 patients who underwent DES implantation into de novo lesions and who underwent coronary angiography and optical coherence tomography （OCT） examination during follow-up were identified. Patients were divided into the CAA group （n=31） and non-CAA group （n=144） based on the results of the coronary angiography. The cardiac events including angina and acute myocardial infarction were noted; in addition, the neointimal thickness and the frequency of strut malapposition and strut uncoverage were also noted. Results A greater proportion of incomplete neointimal coverage （17.17% vs. 1.90%, P 〈0.001） and strut malapposition （18.20% vs. 1.38%, P 〈0.001） were observed in the CAA group. The neointimal thickness in the CAA group was significantly thinner than that in the non-CAA group （（146.6±94.8） μm vs. （192.5＋97.1）μm, P 〈0.001）, as detected via OCT. Patients with CAA formation had a higher frequency of cardiac events including angina pectoris （25.81% vs. 6.25%, P=0.001） and acute myocardial infarction （9.68% vs. 0.13%, P=0.002） and thrombosis （16.13% vs. 0.69%, P 〈0.001）. The longitudinal length of the CAA in the cardiac event group was significantly longer than in the no cardiac event group （（20.0±9.07） mm vs. （12.05±5.38） ram, P=0.005）. Conclusion CAA formation after DES implantation is frequently associated with cardiac events as a result of stent malapposition and incomplete neointimal coverage.