Abstract 12801: Angled Lesions Have Higher Incidence of Vascular Injury and Incomplete Stent Apposition, as Compared to Non-Angled Lesions, Following Stenting: An Optical Coherence Tomography Study

Abstract

Backgrounds: Angled lesions are reported to be associated with worse procedural and clinical outcomes. Recent ex vivo studies have demonstrated that an angled arterial wall is exposed to imbalanced mechanical stress, which can cause vessel injuries and incomplete stent apposition (ISA) following stent implantation. Hypothesis: We tested the hypothesis that the angled coronary lesions, compared to non-angled lesions, would have higher incidence of vascular complications and ISA following stent implantation using optical coherence tomography (OCT) in patients. Methods: A total of 245 lesions treated with a single DES [95 zotarolimus-eluting stent (ZES) and 150 everolimus-eluting stent (EES)] were analyzed using OCT. An angled lesion was defined as a lesion on a curve ≥45° (n=59) on an angiogram and non-angled lesion on a curve <45° (n=186). The frequency was expressed as the percentage of stents with at least one type of injury or strut malapposition. Vessel injury included edge dissection, in-stent dissection, thrombus, and tissue protrusion. ISA was defined when the distance between the center of strut and the vessel wall was >100μm in ZES and >90um in EES. Results: The incidence of edge dissection and tissue protrusion was not significantly different between the groups. However, the incidence of in-stent dissection (84.7% vs 63.4%, P<0.01), thrombus (55.9% vs 35.5%, P<0.01) and ISA (76.3% vs 44.6%, P<0.001) was significantly higher in the angled group. The multivariate analysis demonstrated that the lesion on angle ≥60° was the independent predictor for in-stent dissection [Odds ratio (OR) 4.37, P=0.03] and ISA [OR 7.37, P<0.01], and that the angle ≥45° was the independent predictor for thrombus [OR 2.94, P=0.01]. There was no difference in the OCT findings between the ZES and EES groups. Conclusion: Angled coronary lesions had higher incidence of in-stent dissection, thrombus and ISA compared with non-angled lesions following DES implantation as assessed by OCT.