TCT-375 Comparison of Long Term Outcome After First- and Second-Generation Drug-Eluting Stents in the Treatment of Chronic Total Occlusions: Insights From a Large Registry of 1,343 Consecutive Patients

Abstract

exercise capacity and reduction of mortality. Up to date no adequate information on stent strut endothelialisation after CTO treatment is available. In particular, the duration of dual antiplatelet therapy (DAPT) remains an issue of debate. Following CTO treatment, patients are at risk for restenosis as well as stent thrombosis. DAPT is able to sufficient reduce frequency of stent thrombosis, but keeps an increased risk of major bleeding in case of unnecessarily prolonged ingestion. Intracoronary optical coherence tomography (OCT) is a novel invasive method, which is able to precisely analyse stent strut endothelialisation. We tested the hypothesis, that OCT detects delayed endothelialisation after CTO treatment compared to non-CTO PCI. Methods: We performed diagnostic OCT measurements following successful CTO treatment (n 1⁄4 22) as well as non-CTO DES PCI of complex lesions (n 1⁄4 29). All Patients had been treated with 2nd generation DES. Mean time point of OCT analysis was 7.8 months and 6.5 months, respectively (p 1⁄4 0.83). Results: The two groups were well matched and similar concerning characteristics. Stent struts (in total n 1⁄4 13629) were analysed and classified by OCT according to previously described methods (CTO recanalization vs. non-CTO DES; mean +/SEM): covered struts: 81.65 +/2.9% vs. 97.34 +/0.78%, p<0.0001; protruding/uncovered struts: 10.1 +/1.7% vs. 1.4 +/0.4%, p<0.0001; malapposed/uncovered struts: 7.9 +/2.0 % vs. 1.3 +/0.5 %, p<0.001. We performed subgroup analysis concerning CTO recanalization by antegrade vs. retrograde approach as well as subintimal tracking vs. non-subintimal tracking methods. No significant differences were found concerning subgroup analysis. No MACE events were detected in this series. Conclusions: Here we describe delayed stent endothelialisation after CTO treatment. Our results suggest an urgent need to extend the DAPT after CTO treatment to reduce the risk of late stent thrombosis. OCT allows interventional cardiologists to safe and precisely perform follow-up examinations in patients after CTO recanalization with the ability of individualise the duration of DAPT.