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Zhu Z, Zhu J, Du R, Zhang H, Ni J, Quan W, Hu J, Ding F, Yang Z, Zhang R. Efficacy of Zotarolimus-Eluting Stents in Treating Diabetic Coronary Lesions: An Optical Coherence Tomography Study. Adv Ther 2020; 37:1579-1590. [PMID: 32146703 DOI: 10.1007/s12325-020-01273-6] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2020] [Indexed: 12/11/2022]
Abstract
BACKGROUND Diabetes mellitus (DM) plays an important role in restenosis and late in-stent thrombosis (ST). The current study using optical coherence tomography (OCT) aims to compare target lesion neointima in patients with or without diabetes after zotarolimus-eluting stent (ZES) treatment. METHODS OCT images of 90,212 struts and quantitative coronary angiography (QCA) in 62 patients (32 with DM and 30 without DM) with 69 de novo coronary lesions (34 DM and 35 non-DM) both after ZES implantation and 12 ± 1 month angiographic follow-up were recorded. Patient characteristics, lesion characteristics, clinical outcomes, and OCT findings including neointimal thickness, coverage, malapposition, and intimal morphology were analyzed. RESULTS Baseline patient characteristics and lesion characteristics data were similar between the two groups. Higher neointimal thickness (0.14 ± 0.09 mm vs. 0.09 ± 0.04 mm, p = 0.021), more neovascularization (3.03 ± 6.24 vs. 0.52 ± 1.87, p = 0.017) and higher incidence of layered signal pattern (12.19 ± 19.91% vs. 4.28 ± 9.02%, p = 0.049) were observed in diabetic lesions comparing with non-diabetic lesions. No differences were found in malapposition, uncovered percentage, and thrombus between the two groups (all p > 0.05). Occurrence of clinical adverse events was also similar during the follow-up period (p > 0.05). CONCLUSION Although more neointimal proliferation and more neovascularization were found in diabetic coronary lesions when compared with non-diabetic lesions, treatment with ZES showed similar stent malapposition rate at 1-year follow-up. The data indicated that ZES treatment could possibly be effective in treating diabetic coronary lesions. TRIAL REGISTRATION ClinicalTrials.gov identifier, NCT01747356.
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Affiliation(s)
- Zhengbin Zhu
- Department of Cardiology, Rui Jin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
- Cardiovascular Research Institution, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Jinzhou Zhu
- Department of Cardiology, Rui Jin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
- Cardiovascular Research Institution, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Run Du
- Department of Cardiology, Rui Jin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
- Cardiovascular Research Institution, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Haotian Zhang
- Department of Cardiology, Rui Jin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Jinwei Ni
- Department of Cardiology, Rui Jin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Weiwei Quan
- Department of Cardiology, Rui Jin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Jian Hu
- Department of Cardiology, Rui Jin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Fenghua Ding
- Department of Cardiology, Rui Jin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
- Cardiovascular Research Institution, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Zhenkun Yang
- Department of Cardiology, Rui Jin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Ruiyan Zhang
- Department of Cardiology, Rui Jin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China.
- Cardiovascular Research Institution, Shanghai Jiao Tong University School of Medicine, Shanghai, China.
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Oka N, Kadohira T, Fujii K, Kitahara H, Fujimoto Y, Kobayashi Y. Microbubble contrast enhancement of neointima after drug-eluting stent implantation: an optical coherence tomography study. Heart Vessels 2018; 34:393-400. [PMID: 30187118 DOI: 10.1007/s00380-018-1255-9] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/17/2018] [Accepted: 08/31/2018] [Indexed: 11/26/2022]
Abstract
Microvessels within neoatherosclerosis are associated with vulnerability and increase from the early to the very late phase after drug-eluting stent implantation. Microbubble contrast agents have been suggested to enhance tissue microvasculature for optical coherence tomography (OCT) imaging. The present study investigated whether OCT signal intensity of neointima within stented segments was enhanced after intracoronary administration of microbubble contrast agents. A total of 40 patients who underwent follow-up coronary angiography after drug-eluting stent implantation were enrolled. At the time of follow-up coronary angiography, OCT images of the stented segments were recorded before and after intracoronary administration of microbubble contrast agents. Mean OCT signal intensity of neointima after microbubble administration significantly increased [95.5 (85.7, 106.2) vs. 96.5 (88.7, 109.9), p = 0.001]. Multivariate analysis demonstrated the relationship between diabetes and greater neointima enhancement. The change in the OCT signal intensity of neointima following microbubble administration tended to be higher in diabetic patients than in non-diabetic patients [4.6 (0.6, 8.5) vs. 1.4 (- 1.1, 3.0), p = 0.05]. These findings suggest that this methodology may allow identification of neovascularization in neointima and evaluation of vulnerability of neoatherosclerosis. Microvessels in neointima may be a future target of pharmacological and interventional innovations for preventing stent failure.
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Affiliation(s)
- Norikiyo Oka
- Department of Cardiovascular Medicine, Chiba University Graduate School of Medicine, 1-8-1 Inohana, Chuo-ku, Chiba, Chiba, 260-8677, Japan.
| | - Tadayuki Kadohira
- Department of Cardiovascular Medicine, Chiba University Graduate School of Medicine, 1-8-1 Inohana, Chuo-ku, Chiba, Chiba, 260-8677, Japan
| | - Kenichi Fujii
- Department of Cardiovascular Medicine, Chiba University Graduate School of Medicine, 1-8-1 Inohana, Chuo-ku, Chiba, Chiba, 260-8677, Japan
| | - Hideki Kitahara
- Department of Cardiovascular Medicine, Chiba University Graduate School of Medicine, 1-8-1 Inohana, Chuo-ku, Chiba, Chiba, 260-8677, Japan
| | - Yoshihide Fujimoto
- Department of Cardiovascular Medicine, Chiba University Graduate School of Medicine, 1-8-1 Inohana, Chuo-ku, Chiba, Chiba, 260-8677, Japan
| | - Yoshio Kobayashi
- Department of Cardiovascular Medicine, Chiba University Graduate School of Medicine, 1-8-1 Inohana, Chuo-ku, Chiba, Chiba, 260-8677, Japan
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Feng C, Zhang P, Han B, Li X, Liu Y, Niu D, Shi Y. Optical coherence tomographic analysis of drug-eluting in-stent restenosis at different times: A STROBE compliant study. Medicine (Baltimore) 2018; 97:e12117. [PMID: 30142870 PMCID: PMC6372013 DOI: 10.1097/md.0000000000012117] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
The imaging characteristics of drug-eluting in-stent restenosis (ISR) at different times varied; however, the mechanism had not yet been elucidated.To analyze the imaging characteristics of drug-eluting ISR at different time points by optical coherence tomography (OCT) and investigate the cause of the stent treatment failure.A total of 70 patients with drug-eluting ISR undergoing OCT were enrolled (intimal hyperplasia ≥50% of stent area) and implanted with drug-eluting stents. According to stent implantation time, the patients were divided into 2 groups: early in-stent restenosis group (E-ISR group) (group A, n = 35, stent age ≤12 months) and late in-stent restenosis group (L-ISR group) (group B, n = 35, stent age ≥24 months). A qualitative analysis of the restenosis tissue included the nature of restenosis tissue (homogeneous and heterogeneous), neoatherosclerosis, thin-cap fibroatheroma (TCFA), and microvessels.The ratio of ≥75% cross-sectional area stenosis between the L-ISR and E-ISR groups was (60.00% vs 34.28%, P < .05). The heterogeneous intima, neoatherosclerosis, TCFA, and microvessels were more prevalent in the L-ISR group as compared to the E-ISR group (71.43% vs 45.71%, P < .05; 48.57% vs 22.86%, P < .05; 25.71% vs 5.71%, P < .05; 22.86% vs 2.86%, P < .05, respectively).The morphological characteristics of L-ISR were significantly different from those in the E-ISR; the former was closer to the atherosclerotic plaque, which provided a new approach for the treatment of drug-eluting ISR.
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Affiliation(s)
| | | | | | | | | | | | - Yibing Shi
- Department of Imaging, Xuzhou Central Hospital in Jiangsu,
Institute of Cardiovascular Disease, Xuzhou, China
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Kawashima H, Suzuki N, Kyono H, Mitsui M, Okabe S, Watanabe Y, Ishikawa S, Kozuma K. Incidence and distribution of thin-high signals detected by coronary optical coherence tomography in patients treated with paclitaxel-coated balloon angioplasty for in-stent restenosis. Int J Cardiol 2016; 202:892-3. [PMID: 26476988 DOI: 10.1016/j.ijcard.2015.10.028] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/13/2015] [Accepted: 10/03/2015] [Indexed: 11/26/2022]
Affiliation(s)
- Hideyuki Kawashima
- Department of Medicine, Teikyo University School of Medicine, Tokyo, Japan
| | - Nobuaki Suzuki
- Department of Medicine, Teikyo University School of Medicine, Tokyo, Japan.
| | - Hiroyuki Kyono
- Department of Medicine, Teikyo University School of Medicine, Tokyo, Japan
| | - Miho Mitsui
- Department of Medicine, Teikyo University School of Medicine, Tokyo, Japan
| | - Seiji Okabe
- Department of Medicine, Teikyo University School of Medicine, Tokyo, Japan
| | - Yusuke Watanabe
- Department of Medicine, Teikyo University School of Medicine, Tokyo, Japan
| | - Shuichi Ishikawa
- Department of Medicine, Teikyo University School of Medicine, Tokyo, Japan
| | - Ken Kozuma
- Department of Medicine, Teikyo University School of Medicine, Tokyo, Japan
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The clinical characteristics and prognosis of lesions with in-stent eccentric tissue proliferation and strong signal attenuation detected by optical coherence tomography. Cardiovasc Interv Ther 2015; 31:210-7. [PMID: 26608163 DOI: 10.1007/s12928-015-0369-6] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2015] [Accepted: 11/17/2015] [Indexed: 10/22/2022]
Abstract
There are still some patients who require repeat revascularization despite of drug-eluting stent (DES) implantation. The present study aimed to investigate the relationship between optical coherence tomography (OCT) findings and recurring target lesion revascularization (TLR) after percutaneous coronary intervention (PCI) for in-stent restenosis (ISR). We reviewed 50 patients (54 coronary lesions) who underwent PCI for ISR, which included 25 DES-ISR lesions. The PCI strategy depended on the interventionalist's discretion, and DES implantation was performed for 38 (70 %) lesions. Tissue characteristics were assessed qualitatively and quantitatively using the frame showing maximal lumen narrowing (minimal lumen area). In qualitative analysis, OCT detected coexistence of eccentric tissue proliferation and strong signal attenuation (ESA). ESA was observed in six lesions (11 %) in five patients (10 %). Hemodialysis (80 vs. 20 %, p = 0.013) and DES-ISR (100 vs. 40 %, p = 0.0069) were significantly more frequent in ESA patients/lesions than in others. One-year follow-up revealed that re-TLR was more frequently performed for ESA lesions (83 vs. 8 %, p = 0.0002). The findings reveal that ESA detected in OCT images of ISR is related to TLR after PCI for DES-ISR especially in patients undergoing maintenance hemodialysis.
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Affiliation(s)
- Nobuaki Suzuki
- Department of Medicine, Teikyo University School of Medicine
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Comparison of Neoatherosclerosis and Neovascularization Between Patients With and Without Diabetes. JACC Cardiovasc Interv 2015; 8:1044-1052. [DOI: 10.1016/j.jcin.2015.02.020] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/03/2014] [Revised: 01/21/2015] [Accepted: 02/12/2015] [Indexed: 11/30/2022]
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Fu Q, Suzuki N, Kozuma K, Miyagawa M, Nomura T, Kawashima H, Shiratori Y, Ishikawa S, Kyono H, Isshiki T. Quantitative optical coherence tomography analysis for late in-stent restenotic lesions. Int Heart J 2014; 56:13-7. [PMID: 25503658 DOI: 10.1536/ihj.14-136] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
Coronary optical coherence tomography (OCT) has the potential to identify in-stent neoatherosclerosis, which is a possible risk factor for late acute coronary events after drug-eluting stent implantation. The purpose of this study was to investigate differences between mid-term and late in-stent restenosis after stent implantation by quantitative and semiautomated tissue property analysis using OCT. In total, 1063 OCT image frames of 16 lesions in 15 patients were analyzed. This included 346 frames of 6 lesions in late in-stent restenosis, which was defined as restenosis that was not detected at 6 to 12 months but ≥ 12 months after follow-up coronary angiography. Signal attenuation was circumferentially analyzed using a dedicated semiautomated software. Attenuation was assessed along 200 lines delineated radially for analysis of the in-stent restenotic lesions (between the lumen and stent contours). All lines were anchored by the image wire to avoid artifacts resulting from wire location. Stronger signal attenuation at the frame level (2.46 ± 0.78 versus 1.47 ± 0.32, P < 0.001) and higher maximum signal intensity at the lesion level (9.19 ± 0.19 versus 8.84 ± 0.32, P = 0.018) were observed in late in-stent restenotic lesions than in mid-term in-stent restenotic lesions. OCT demonstrated stronger signal attenuation and higher maximum signal intensity in late in-stent restenotic lesions than in mid-term in-stent restenotic lesions, indicating the possibility of neoatherosclerosis.
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Affiliation(s)
- Qiang Fu
- Department of Medicine, Teikyo University School of Medicine, Tokyo, Japan; Department of Cardiology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
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