Healing course of acute vessel wall injury after drug-eluting stent implantation assessed by optical coherence tomography

摘要

Background Vessel wall injury after drug-eluting stent (DES) implantation can be characterized in detail by optical coherence tomography (OCT). Little is known about the healing course of these phenomena. Methods and results In 62 lesions (62 patients), the incidence of acute vessel trauma was assessed in the stented region and the edge segments immediately after DES implantation. The healing course of these injuries was assessed at 9-month OCT follow-up using a software algorithmallowing for reliable spatialcomparisonofbaselineandfollow- upcross-sectionalimages.Tissue prolapse (TP) and tissue protrusions were detected in 81 and 35% of lesions, respectively. A total of 342 intra-stent dissection flaps (ISD) and 114 intra-stent dissection cavities (ISC) were visualized in 98 and 81% of lesions, respectively. Thirty-five lesions (56%) showededgedissections (EDs). No residual TPor protrusion was observedat follow-up. Incomplete healing was seen in 8% of ISD and in 20% of ISC. ForED, a residual flap was observed in one-third of the initially dissected stent edges. Incomplete healing of acute vessel injurywas associatedwith the presence of underlying at herosclerotic disease atbaseline.Uncovered and malapposed stent struts were observed more often with incomplete healing of vessel injury at follow-up. Conclusions Acute vessel wall trauma is highly prevalent immediately after DES implantation. Most of these injuries are minor and resolve at mid-term follow-up. Incomplete healing of ISDs seems to be associated with other OCT findings suggesting delayed arterial healing.