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Effects of TCFA on stent neointimal coverage at 9 months after EXCEL drug-eluting stent implantation assessed by OCT

Auswirkungen von TCFA auf die neointimale Abdeckung des Stents 9 Monate nach Implantation eines medikamentenfreisetzenden EXCEL-Stents, bewertet durch OCT

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Abstract

Background

The aim of this study was to investigate the effects of thin-cap fibroatheromas (TCFAs) on stent neointimal coverage at the 9‑month follow-up after EXCEL stent implantation assessed by optical coherence tomography (OCT).

Methods

A total of 93 patients with non-ST elevation acute coronary syndrome (NSTEACS) who underwent EXCEL stent implantation were prospectively enrolled in the study and divided into a TCFA group (n = 47) and a non-TCFA group (n = 46) according to whether EXCEL stents covered the TCFAs. A TCFA was defined as a plaque with lipid content in more than one quadrant and fibrous cap thickness measuring less than 65 μm. The effect of TCFAs on stent neointimal coverage at the 9‑month follow-up after stent implantation was evaluated by OCT. The primary study endpoints were the incidence of neointimal uncoverage and stent malapposition.

Results

At the 9‑month follow-up, the minimal lumen diameter of the TCFA group tended to be smaller (2.8 ± 0.8 vs. 2.1 ± 0.8, p = 0.08) and the diameter of stenosis in the TCFA group tended to be larger (15.1 ± 10.3% vs. 26.3 ± 15.1%, p = 0.08) than those in the non-TCFA group. The mean intimal thickness of the TCFA group was significantly lower than that of the non-TCFA group (67.2 ± 35.5 vs. 145.1 ± 48.7, p < 0.001). The uncovered struts (10.1 ± 9.7 vs. 4.8 ± 4.3, p = 0.05) and malapposed struts (2.1 ± 4.7 vs. 0.3 ± 0.5, p = 0.003) in the TCFA group were more significant than those in the non-TCFA group. Multivariate analysis showed that TCFAs and lesion types were independent predictors of incomplete neointimal coverage (p < 0.05), and lesion types were independent predictors of stent malapposition (p < 0.05).

Conclusion

In patients with NSTEACS, TCFAs delayed endothelium coverage at 9 months after stent implantation, and TCFAs were independent predictors of incomplete neointimal coverage of the stent.

Zusammenfassung

Ziel

Mittels optischer Kohärenztomographie (OCT) sollten die Auswirkungen von Fibroatheromen mit dünner Endothelschicht (TCFA) auf die neointimale Abdeckung von Stents bei der 9‑Monats-Nachuntersuchung nach EXCEL-Stentimplantation untersucht werden.

Methoden

Prospektiv wurden 93 Patienten mit akutem Koronarsyndrom ohne ST-Hebung, die eine EXCEL-Stentimplantation erhielten, in die TCFA-Gruppe (n = 47) und die Nicht-TCFA-Gruppe (n = 46) eingeteilt, je nachdem, ob EXCEL-Stents TCFA bedeckten. Ein TCFA wurde als Plaque mit Lipidgehalt in > 1 Quadranten und einer Dicke der Faserkappe von weniger als 65 µm definiert. Die Wirkung von TCFA auf die neointimale Abdeckung der Stents bei der Nachuntersuchung nach 9 Monaten nach der Stentimplantation wurde mittels OCT bewertet. Die primären Studienendpunkte waren die Inzidenz der Feststellung einer Neointima und einer Stent-Fehlpositionierung.

Ergebnisse

Bei der Nachuntersuchung nach 9 Monaten war der minimale Lumendurchmesser der TCFA-Gruppe tendenziell kleiner (2,8 ± 0,8 vs. 2,1 ± 0,8; p = 0,08) und der Durchmesser der Stenose in der TCFA-Gruppe tendenziell größer (15,1 ± 10,3 % vs. 26,3 ± 15,1 %; p = 0,08) als in der Nicht-TCFA-Gruppe. Die mittlere Intimadicke der TCFA-Gruppe war signifikant geringer als die der Nicht-TCFA-Gruppe (67,2 ± 35,5 vs. 145,1 ± 48,7; p < 0,001). Die unbedeckten Streben (10,1 ± 9,7 vs. 4,8 ± 4,3; p = 0,05) und die fehlangelegten Streben (2,1 ± 4,7 vs. 0,3 ± 0,5; p = 0,003) in der TCFA-Gruppe waren signifikanter als die in der Nicht-TCFA-Gruppe. Die multivariate Analyse zeigte, dass TCFA und Läsionstypen unabhängige Prädiktoren für eine unvollständige neointimale Abdeckung (p < 0,05) und Läsionstypen unabhängige Prädiktoren für eine Stent-Fehlpositionierung (p < 0,05) waren.

Schlussfolgerung

Bei Patienten mit akutem Koronarsyndrom ohne ST-Hebung verzögerten TCFA die Endothelabdeckung 9 Monate nach der Stentimplantation, und TCFA waren unabhängige Prädiktoren für eine unvollständige neointimale Abdeckung des Stents.

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Funding

This work was supported by the Beijing Municipal Science and Technology Project (Z161100000516091).

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Authors and Affiliations

  1. Department of Cardiology, Beijing Electric Power Hospital, State Grid Corporation, Beijing, China

    Jiao Zhang, Hong Yu, Limin Jing & Huiliang Liu

  2. Department of Geriatrics, The Second Medical Center & National Clinical Research Center for Geriatric Diseases, Chinese PLA General Hospital, Beijing, China

    Yuanyuan Duan

  3. Department of Cardiology, The Third Medical Center of Chinese PLA General Hospital, No.69 Yongding Road, Haidian District, 100089, Beijing, China

    Jiao Zhang, Yi Li, Xiaowei Jia, Dekui Jin & Huiliang Liu

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  1. Jiao Zhang
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Contributions

J. Zhang, Y. Duan, H. Yu, and H. Liu were involved in the study conception and design, data acquisition, and data analysis. J. Zhang and Y. Duan drafted the manuscript. H. Yu and H. Liu revised the manuscript. L. Jing, Y. Li, X. Jia and D. Jin were involved in the analysis or interpretation of data. All authors read and approved the final manuscript. All authors gave final approval for this version to be published.

Corresponding author

Correspondence to Huiliang Liu.

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Conflict of interest

J. Zhang, Y. Duan, H. Yu, L. Jing, Y. Li, X. Jia, D. Jin, and H. Liu declare that they have no competing interests.

All procedures performed in studies involving human participants or on human tissue were in accordance with the ethical standards of the institutional and/or national research committee and with the 1975 Helsinki declaration and its later amendments or comparable ethical standards. This study was approved by the Ethics Committee of the Third Medical Center of Chinese PLA General Hospital, and written informed consent was obtained from all individual participants included in the study.

Additional information

J. Zhang, Y. Duan, and H. Yu contributed equally to this work.

Availability of data and material

The data used to support the findings of this study are available from the corresponding author upon request.

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Zhang, J., Duan, Y., Yu, H. et al. Effects of TCFA on stent neointimal coverage at 9 months after EXCEL drug-eluting stent implantation assessed by OCT. Herz 48, 64–71 (2023). https://doi.org/10.1007/s00059-021-05095-2

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  • DOI: https://doi.org/10.1007/s00059-021-05095-2

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