Long-term Outcomes of Minor Dissection at the Edge of Coronary Stents Detected with Intravascular Ultrasound

BACKGROUND: The impacts of minor non-flow limiting dissections at the edge of stents on the late clinical outcomes are unknown. Therefore, we evaluated the influences of minor edge dissections on late angiographic in-stent restenosis. SUBJECTS & METHODS: Intravascular ultrasound (IVUS) guided single coronary stenting was successfully performed in 390 consecutive patients with 420 native coronary lesions. Six-month follow-up angiogram was performed in 327 patients (83.9%) with 348 lesions (82.9%). RESULTS: Proximal or distal minor edge dissections were observed in 67 of 348 lesions (19.3%) (proximal in 26 lesions, distal in 37 and both in 4). In distal reference segments, lumen areas and diameters were significantly smaller in the lesions with minor edge dissection (p=.037 and 0.025, respectively). The overall angiographic restenosis rate was 26.2% (91/ 348); 29.9% (20/67) in the lesions with minor edge dissections vs. 25.3% (71/281) in the lesions without minor edge dissections (p=.540). All minor dissections disappeared and were completely healed at follow-up IVUS study. CONCLUSION: Minor non-flow limiting dissections at the edge of stents might not be associated with the development of late angiographic in-stent restenosis.

Long-term Outcome of Minor Plaque Prolapsed within Stents Documented with Intravascular Ultrasound

BACKGROUND: The direct relationship between minor plaque prolapsed within stents and late in-stent restenosis is unknown. Therefore, we evaluated the impact of minor plaque prolapse on late angiographic in-stent restenosis. MATERIALS AND METHODS: Intravascular ultrasound (IVUS) guided single-coronary stenting was successfully performed in 384 consecutive patients with 407 native coronary lesions. Six-month follow-up angiogram was performed in 315 patients (82.0%) with 334 lesions (82.1%). Minor plaque prolapsed within stent occurred in 75 of 334 lesions (22.5%). Results were evaluated using angiographic and IVUS methodology. RESULTS: The development of minor plaque prolapse was significantly associated with infarct-related artery (p=.000) and smaller pre-intervention minimal lumen diameter (p=.001). The overall angiographic restenosis rate was 23.1% (77/ 334); 21.3% (16/75) in the lesions with plaque prolapse vs. 23.6% (61/259) in the lesions without plaque prolapse (p=.806). CONCLUSION: Minor plaque prolapsed within stents might not be associated with late angiographic in-stent restenosis.

Intravascular Ultrasound Findings of Arterial Remodeling at the Sites of Focal Coronary Spasm in Patients with Vasospatic Angina

BACKGROUND: There is little data about the intravascular ultrasound (IVUS) findings in the patients with vasospastic angina, especially with respect to patterns of vascular remodeling. METHODS: Coronary spasm was documented by angiography and ECG evidence of ischemia in 36 patients after administration of ergonovine (cumulative doses up to 350 microgram). After relief of spasm using 1,000 microgram of intracoronary nitroglycerin, IVUS imaging was performed and analyzed using standard methodology. The 36 focal spasm sites were compared to the proximal and distal reference segments. RESULTS: The angiographic baseline minimum lumen diameter measured 1.78+/-0.66mm, which decreased to 0.66+/-0.38mm with ergonovine provocaton (pproximal reference) was present in 5; intermediate remodeling (proximal reference >spasm site >distal reference arterial area) was present in 7; and negative remodeling (spasm site arterial area