Stent Edge Research Articles

Predictors and incidence of stent edge dissections in patients with type 2 diabetes as determined by optical coherence tomography

Patients with type 2 diabetes are at increased risk for post-PCI complications including stent thrombosis and restenosis. Stent edge dissections (SEDs) have been associated with these complications. This study assessed incidence and predictors of SEDs in patients with type 2 diabetes using optical coherence tomography (OCT). Intravascular lesion parameters and plaque morphology were investigated pre- and post-PCI using OCT in 73 type 2 diabetic patients with 90 lesions and 166 visible stent edges. We detected 42 (25.3 %) SEDs in 166 stent edges and 37 (41.1 %) SEDs in 90 lesions. More SEDs occurred if the border of the stent had been placed within diseased vessel segments with predominantly fibrous (42.9 %) and fibrocalcific (40.5 %) plaques compared to healthy vessel wall morphology (p < 0.001). Furthermore, the lumen eccentricity of the stent at its edges (SAE) (16.00 ± 6.07 vs. 13.11 ± 5.22 %, p < 0.003) and the stent-edge-to-lumen-area-ratio (1.26 ± 0.27 vs. 0.99 ± 0.20, p < 0.001) were both significantly larger in the presence of SEDs. All of the above parameters were significant predictors for SEDs on uni- and multivariate logistic regression analysis (all p < 0.01), suggesting that the lumen eccentricity of the SAE, the stent-edge-to-lumen-area-ratio and diseased vessel wall morphology of the reference segment adjacent to the stent edge are independent risk factors for the presence of SEDs. These results suggest that diseased vessel wall morphology at the stent edges may promote the occurrence of SEDs and that avoidance of longitudinal and transverse mismatch between stent and vessel could be important to reduce SEDs in cardiovascular high-risk patients with type 2 diabetes.

Head‐to‐head comparison of sirolimus‐eluting stent versus bare metal stent evaluation of the coronary endothelial dysfunction in the same patient presenting with multiple coronary artery lesions: The CREDENTIAL study

To assess the endothelial dysfunction (ED) after bare metal stents (BMS) and sirolimus eluting stents (SES) implantation in the same patient, overcoming the confounding role of individual variables. SES reduce restenosis rate compared to BMS but causes more ED. ED is a potentially unsafe phenomenon, since it is the first step in the cascade of atherosclerosis. Studies showing more pronounced ED with drug eluting stents than BMS involved different series of patients, making the comparison difficult because endothelial function (EF) is responsive to many risk factors. we designed a prospective comparison of 6 months post-deployment EF of SES versus BMS implanted in the same patient, but in different coronary segments. Forty-eight lesions were randomly assigned on a 1:1 allocation using block sizing of 4 according to a computer-generated sequence (SAS System, Version 9.1) basis to treatment with SES or BMS. The EF was evaluated by measuring vessel diameter variation in the stented segment, before and after selective intracoronary infusion of acetylcholine (iiAch). In eligible patients, the relative magnitudes of major vasoconstriction were 2.6, 2.9, 4.6, and 3.1 at 5 mm proximal and 5, 10 and 20 mm distal to the stent edge. Overall, a 3.5-fold major distal vasoconstriction after iiAch of SES vs. BMS was calculated. in the same patients, but treating different coronary segments, SES implantation induces a higher rate of vasoconstriction compared to BMS. The increased vasoconstriction after iiAch is an indicator of ED.

Lipid rich plaque, female gender and proximal coronary stent edge dissections

We hypothesized that women are more prone to develop coronary dissections during PCI due to potential balloon-oversizing or gender specific plaque and vascular characteristics. To date, a gender related difference in edge dissection has not been systematically studied. The Massachusetts General Hospital Optical Coherence Tomography (MGH OCT) Registry is an international registry of patients undergoing OCT procedures. We identified 206 consecutive patients (159 men, 47 women) with stable or unstable coronary syndromes demonstrating adequate OCT images for gender specific comparison in areas of non-overlapping stents. Presence of proximal edge dissection, its characteristics, plaque composition at stent borders and luminal diameters were assessed. A multivariate logistic regression model was applied to determine if female gender was predictive of proximal coronary dissection after adjusting for clinical, procedural and plaque characteristics. Proximal coronary dissection was significantly more common in women as compared to men (30.6 vs 15.6%, p = 0.02). No gender differences were observed in age, presentation, and stents per patient or plaque characteristics. The characteristics of edge dissections were different in women compared to men with a significant female predisposition to more complex proximal coronary dissection. In multivariable analysis, female gender was not a predictor of coronary dissection; on the other hand, stent oversizing and especially lipid rich plaque at proximal edge were independent predictors of proximal dissection. OCT confirms that female gender is associated with a greater than twofold increased risk of developing proximal coronary edge dissections as compared to men. But, the most potent independent predictor of proximal coronary edge dissection is the presence of a proximal lipid rich plaque.

In vivo comparison of lumen dimensions measured by time domain-, and frequency domain-optical coherence tomography, and intravascular ultrasound

Lumen dimensions measured by time-domain optical coherence tomography (TD-OCT) may be influenced by the hemodynamic effect of proximal balloon occlusion. Frequency-domain OCT (FD-OCT) does not require the interruption of blood flow. Therefore, we compared the coronary lumen dimensions measured by TD-OCT, FD-OCT, and intravascular ultrasound (IVUS) in both stented and non-stented segments. Twenty patients who underwent both IVUS and OCT imaging (10 for TD- and 10 for FD-OCT) after stent implantation were included. The maximum, minimum, and mean diameters and areas were measured at the proximal and distal stent edges, as well as 3 mm inside and 5 mm outside of both edges. The measurements inside stent showed no significant differences between IVUS and TD- or FD-OCT. The lumen mean diameters and areas measured by IVUS at 5 mm outside stent were similar to those measured by FD-OCT (Distal; 3.07 ± 0.7 vs 3.03 ± 0.7 mm, p = 0.08 and 7.80 ± 4.0 vs 7.72 ± 4.1 mm(2), p = 0.07, respectively. Proximal; 3.25 ± 0.7 vs 3.23 ± 0.7 mm, p = 0.09 and 8.78 ± 3.8 vs 8.65 ± 3.7 mm(2), p = 0.08, respectively), but were greater than those measured by TD-OCT (Distal; 2.75 ± 0.5 vs 2.29 ± 0.5 mm, p = 0.0001 and 6.15 ± 2.6 vs 4.38 ± 1.9 mm(2), p = 0.0002, respectively. Proximal; 3.27 ± 0.6 vs 2.69 ± 0.6 mm, p = 0.0001 and 8.64 ± 3.4 vs 6.12 ± 2.7 mm(2), p = 0.0001 respectively). The interaction between TD- and FD-OCT for lumen dimension measurements at 5 mm outside stent was statistically significant. Vessel dimension measurements were similar between IVUS and FD-OCT in native vessel unlike with TD-OCT. Therefore, we might adapt the IVUS criteria of lesion severity for percutaneous coronary intervention to FD-OCT.

Natural consequence of post-intervention stent malapposition, thrombus, tissue prolapse, and dissection assessed by optical coherence tomography at mid-term follow-up

AimsWe performed this study to clarify natural consequences of abnormal structures (stent malapposition, thrombus, tissue prolapse, and stent edge dissection) after percutaneous coronary intervention (PCI).Methods and resultsThirty-five patients treated with 40 drug-eluting stents underwent serial optical coherence tomography (OCT) imaging immediately after PCI and at the 8-month follow-up. Among a total of 73 929 struts in every frame, 431 struts (26 stents) showed malapposition immediately after PCI. Among these, 49 remained malapposed at the follow-up examination. The mean distance between the strut and vessel wall (S–V distance) of persistent malapposed struts on post-stenting OCT images was significantly longer than that of resolved malapposed struts (342 ± 99 vs. 210 ± 49 μm; P <0.01). Based on receiver-operating characteristic curve analysis, an S–V distance ≤260 µm on post-stenting OCT images was the corresponding cut-off point for resolved malapposed struts (sensitivity: 89.3%, specificity: 83.7%, area under the curve = 0.884). Additionally, 108 newly appearing malapposed struts were observed on follow-up OCT, probably due to thrombus dissolution or plaque regression. Thrombus was observed in 15 stents post-PCI. Serial OCT analysis revealed persistent thrombus in 1 stent, resolved thrombus in 14 stents, and late-acquired thrombus in 8 stents. Tissue prolapse observed in 38 stents had disappeared at the follow-up. All eight stent edge dissections were repaired at the follow-up.ConclusionMost cases of stent malapposition with a short S–V distance, thrombus, tissue prolapse, or minor stent edge dissection improved during the follow-up. These OCT-detected minor abnormalities may not require additional treatment.

Biomechanical responses after Wingspan Stent deployment in swine ascending pharyngeal artery

Objectives: Symptomatic intracranial atherosclerotic stenosis is associated with a high rate of recurrent stroke. Endovascular angioplasty and stenting using the WingspanTM Stent (Stryker) has been used for treatment of this disorder. However, a recent randomized trial (SAMMPRIS Clinical Trial) reported that it was inferior to aggressive medical management. To explore the cause of stroke complications after treatment with the Wingspan Stent, we simulated the biomechanical responses in a swine ascending pharyngeal artery (APA) using the finite element method.Methods: A Wingspan Stent was deployed in a swine APA, and simulated stress distributions including radial, circumferential, and wall shear stress were evaluated. Histopathological analysis of the selected APA was made 28 days post-stenting.Results: We detected increased radial stress concentration at distal stent markers with a stent edge and a graded augmentation of radial stress from proximal to distal. There was an impaired wall shear stress near the stent struts and stent markers. Intense neointimal hyperplasia was observed from the middle to distal segment of the stent 28 days after the procedure.Discussion: This preliminary data suggest that the Wingspan Stent produces increased radial stress distribution with distal segment in a tapering artery. It is possible that the radial stress concentration plays a role in the development of neointimal hyperplasia.

Mechanism of Edge Restenosis After Drug-Eluting Stent Implantation

Edge restenosis is not an unusual finding after implantation of drug-eluting stents (DES). We hypothesized that mechanical stress imposed on the stent edge would cause vessel wall injury and inflammation, which may consequently lead to edge restenosis. In total, 1,496 patients were implanted with a sirolimus-eluting stent (SES), paclitaxel-eluting stent (PES) or zotarolimus-eluting stent (ZES) in Seoul National University Hospital between 2007 and 2009. Binary restenosis occurred in 161 lesions in 119 patients. We retrospectively compared the 3 DES with regard to the percentage of edge stent restenosis among all cases of restenosis. We also evaluated the maximal, minimal, and Δ (maximal angle-minimal angle) angles. The percentage of edge restenosis was higher for SES than for ZES (37.5% vs. 16.7%, P=0.017). Maximal angle at the proximal edge was 64.82°±33.46° for 26 stents with proximal edge restenosis compared with 31.84°±31.51° for 89 stents without proximal edge restenosis (P=0.001). The Δ angle was also significantly different between the 2 groups (14.81°±15.98° vs. 7.60°±8.86°, P=0.035). Similar findings were observed for distal edge restenosis. Both the maximal angle (39.09°±21.04° vs. 22.71°±22.83°, P=0.010) and Δ angle (20.23°±15.39° vs. 9.18°±9.66°, P=0.016) at the distal edge were significantly different between the 2 groups. Physical stress determined by angulation at the stent edge segment and biomechanical properties of the DES can be considered as one of the plausible mechanisms for edge stent restenosis.

Usefulness of Functional Assessment in the Treatment of Patients With Moderate Angiographic Paclitaxel-Eluting Stent Restenosis

In recent years there has been a debate about the functional severity of restenosis of drug-eluting stents. The aim of the present study was to assess the functional severity of stenosis in patients with moderate angiographic restenosis after paclitaxel-eluting stents (PES) deployment. Forty-two patients with moderate angiographic restenosis at the in-stent segment and/or approximately 5mm from the stent edge were enrolled. For comparison, furthermore, 42 patients with de novo stenosis lesions matched for angiographic severity were assigned to the control group. Quantitative coronary angiography and functional assessment using fractional flow reserve (FFR) were performed. Although percent diameter stenosis was not significantly different between the 2 groups (PES group, 40.6±11.2%; de novo group, 40.6±9.0%, P=0.981), the functional severity of stenosis was significantly less in the PES group than in the de novo group (FFR: PES group, 0.86±0.07; de novo group, 0.79±0.10, P=0.002). FFR was preserved in patients with moderate angiographic restenosis after PES deployment, and the functional severity of restenosis is often limited. Therefore, revascularization should be performed with caution for patients with moderate angiographic restenosis after PES deployment.

Impact of Post-Procedural Intravascular Ultrasound Findings on Long-Term Results Following Self-Expanding Nitinol Stenting in Superficial Femoral Artery Lesions

Previous intravascular ultrasound (IVUS) studies have reported that a tiny reference cross-sectional area (CSA), stent under-expansion, stent asymmetry, stent edge dissection, and tissue protrusion are associated with target lesion revascularization (TLR) after coronary intervention. In the lower limb, however, it has not been reported that these findings correlate with TLR after endovascular therapy (EVT). A total of 236 consecutive superficial femoral artery (SFA) lesions in patients who underwent IVUS after self-expanding nitinol stent implantation, were analyzed. Stent expansion ratio was calculated as minimum stent CSA/reference lumen CSA, radial stent symmetry index as minimum/maximum stent diameter, and axial stent symmetry index as minimum/maximum stent CSA. TLR was defined as clinically driven revascularization with ≥75% restenosis of the target lesion. The mean follow-up period was 34±15 months. TLR were performed in 42 lesions (17.8%). There were no significant differences in stent expansion ratio, stent symmetry indices, and tissue protrusion between the TLR and no-TLR groups. Multivariate analysis indicated that total stent length (odds ratio [OR], 1.004; P<0.05), distal reference CSA (OR, 0.91; P<0.01), and stent edge dissection (OR, 3.51; P<0.01) were independent predictors of TLR. Stent implantation in tiny vessels and stent edge dissection in SFA lesions are indicators of high risk of TLR. Post-procedural stent under-expansion and stent asymmetry, however, were not associated with TLR.

A Case of Complex Restenosis of Aortoiliac Stent Mimicking Downward Stent Migration

We present the case of aortoiliac stent restenosis which was caused by 13 years’ of neointimal progression within and at the edge of the aortoiliac stent at the iliac bifurcation. A 74 year-old man presented with vertigo. We planned 4-vessel cerebral angiography through the right common femoral artery to evaluate his carotid artery but failed due to the catheter jam against the struts of the previously deployed aortoiliac stent. Retrograde sheath angiography through the right femoral artery indicated that the previously implanted stent seemed to have migrated in a downward direction and be embedded in the internal iliac artery. While comparing with the previous angiograms, we found that the implanted stent did not migrate downwardly but was separated from the external iliac artery by newly formed septum of neointimal hyperplasia. We successfully reopened the stenosis using the contralateral approach after widening the struts of the previously deployed T-stents.

Association Between Proximal Stent Edge Positioning on Atherosclerotic Plaques Containing Lipid Pools and Postprocedural Myocardial Infarction (from the CLI-POOL Study)

Postprocedural myocardial infarction is an ominous complication of percutaneous coronary intervention (PCI). Despite several patient, lesion, and procedural factors that may affect its occurrence and severity, it is unclear if implanting a stent edge on a coronary lipid pool, as appraised by optical coherence tomography (OCT), adversely affects outcomes. The aim of this study was to assess the association between postprocedural myocardial infarction and the implantation of a stent edge on a lipid pool, as assessed by OCT. A database was screened for patients without ongoing myocardial infarctions; who underwent PCI with stenting for single, native, de novo lesions; without periprocedural side-branch occlusion or compromise; who underwent post-PCI OCT; and had postprocedural myocardial infarctions. These subjects were matched 1:1 with patients with similar features but without postprocedural myocardial infarctions. Plaque characterization with OCT was performed using established criteria. Specifically, lipid pools within stent edges were quantified by computing the number of involved quadrants and the degree of lipid arc on cross-sectional images. A total of 30 patients were included (15 with postprocedural myocardial infarctions and 15 controls without infarctions). Whereas no patient or control subject had lipid pools in correspondence to distal stent edges, landing of proximal stent edges on lipid pools was significantly more frequent in patients than in controls (10 [66%] vs 2 [13%], p= 0.009), Moreover, patients with postprocedural myocardial infarctions had more extensive lipid pools at proximal stent edges than those without postprocedural myocardial infarctions. Accordingly, lipid pool arc at proximal stent edge was significantly associated with peak post-PCI creatine kinase-MB/upper limit of normal ratio (Spearman's ρ= 0.49, p=0.006). In conclusion, incomplete stent coverage of coronary lipid pools appears to be associated with an increased risk for postprocedural myocardial infarction in patients who undergo PCI.

Clinical validation of the new T‐ and Y‐Shape models for the quantitative analysis of coronary bifurcations: An interobserver variability study

This article presents the results of an interobserver validation study of our new T- and Y-shape bifurcation models including their edge segment analyses. Over the last years, the coronary artery intervention procedures have been developed more and more toward bifurcation stenting. Because traditional straight vessel quantitative coronary arteriography (QCA) is not sufficient for these measurements, the need has grown for new bifurcation analysis methods. In this article, our two new bifurcation analysis models are presented, the Y-shape and T-shape model. These models were designed for the accurate measurement of the clinically relevant parameters of a coronary bifurcation, for different morphologies and intervention strategies and include an edge segment analysis, to accurately measure (drug-eluting) stent, stent edge, and ostial segment parameters. The results of an interobserver validation study of our T-shape and Y-shape analyses are presented, both containing the pre- and post-intervention analyses of each 10 cases. These results are associated with only small systematic and random errors, in the majority of the cases compliant with the QCA guidelines for straight analyses. The results for the edge segment analyses are also very good, with almost all the values within the margins that have been set by our brachytherapy directive. Our new bifurcation approaches including their edge segment analyses are very robust and reproducible, and therefore a great extension to the field of quantitative coronary angiography.

Deployment of self‐expandable stents for complex proximal superficial femoral artery lesions involving the femoral bifurcation with or without jailed deep femoral artery

To (1) compare the outcome of self-expandable stents with versus without jailed deep femoral artery (DFA) for proximal superficial femoral artery (SFA) lesions, and to (2) ascertain the fate of jailed DFA. Complex SFA lesions involving the femoral bifurcation (FB) was mostly treated surgically, and the role played by endovascular procedures is uncertain. We retrospectively identified 104 consecutive, de novo lesions involving the SFA ostium, stented between April 2005 and September 2010. Depending on the proximal stent edge location, the sample was divided between 60 distal common femoral artery (CFA) stenting with jailed DFA and 44 ostial SFA stenting without jailed DFA. The FB was the segment beginning in the distal CFA, 10 mm proximal to the DFA ostium and ending in the SFA and 10 mm distal to the carina. Stented CFA lesions proximal to the FB were excluded. The bifurcation was classified as patent when free of restenosis and repeat revascularization. The overall 12-month bifurcation and primary patency rates were 72.5% and 52.0%, respectively. Predictors of loss of bifurcation patency were ostial SFA stenting and a small stent in the FB. Bifurcation patency (83.3% vs. 56.3%; P < 0.01) and primary patency of the SFA (56.2% vs. 37.5%; P = 0.088) were higher after distal CFA than after ostial SFA stenting. In 95.7% of distal CFA and 100% of ostial SFA stenting, DFA remained patent at 12-month follow-up (P = 0.237). The 12-month fate of jailed DFA after distal CFA stenting was acceptable, and the bifurcation patency rate was higher than after ostial SFA stenting.

Long‐term outcome of transcatheter polytetrafluoroethylene‐covered stent implantation in a giant coronary aneurysm of a child with Kawasaki disease

We report the long-term outcome of a child with Kawasaki disease (KD), who had a giant aneurysm with stenotic lesions in the right coronary artery, resulting in the transcatheter implantation of a polytetrafluoroethylene (PTFE)-covered stent at the age of 8. Quantitative coronary angiography analysis later showed the increase of the diameter stenosis at both stent edges for the first 10 months after implantation; however, the stenosis did not develop thereafter. Coronary perfusion was still well maintained at follow-up coronary angiography 5.5 years after implantation (diameter stenosis was 36.5% at proximal and 37.4% at distal edge, respectively). Although further follow-up is necessary, the long-term outcome of a PTFE-covered stent implantation for a KD patient is satisfactory in this instance. Implantation of a covered stent in a giant aneurysm is considered a promising treatment option.

Optical Coherence Tomography

Case presentation : A 56-year-old man presented to the hospital with chest pain and a non–ST-segment elevation myocardial infarction. Thrombotic plaque rupture in the left anterior descending coronary artery was treated with an everolimus-eluting stent. After stent deployment, angiography demonstrated the presence of a hazy opacity at the distal edge of the stent, and there was concern about a possible edge dissection. Optical coherence tomography (OCT) imaging of the opacity showed residual thrombus and no dissection. Subsequent aspiration thrombectomy and balloon dilation effectively treated the lesion without deployment of an additional stent. OCT is an intravascular imaging modality that utilizes near-infrared light to generate cross-sectional blood vessel images. OCT is similar to intravascular ultrasound (IVUS), and both OCT and IVUS provide information about intravascular anatomy that far exceeds the level of detail obtained from conventional contrast cineangiography. With the use of light rather than ultrasound reflectance, OCT generates in vivo images of coronary arteries and deployed stents with up to 10 to 15 μm of spatial resolution compared with the 100- to 200-μm resolution of IVUS. Although the spatial resolution of OCT is markedly superior to that of IVUS, near-infrared light does not penetrate tissue as effectively as sound, and therefore OCT imaging depths range from 1 to 3 mm into the vessel wall, whereas IVUS imaging depths range from 4 to 10 mm (Table). Additionally, near-infrared light is scattered by red blood cells, and therefore OCT imaging requires transient blood clearing during image acquisition. View this table: Table. Comparison of FD-OCT and IVUS The speed of light was initially a central challenge to developing a “clinically friendly” OCT system. Light travels too quickly for direct measurement of differential reflectance caused by vascular structures, and the original time delay OCT (TD-OCT) systems utilized a moving reference mirror to calibrate reflected light waves for image …

THE ANGIOGRAPHIC FEATURES AND EFFECT OF DRUG TREATMENT OF SPONTANEOUS CORONARY ARTERY DISSECTION

ObjectivesTo study the angiographic features and effects of drug treatment of spontaneous coronary artery dissection (SCAD).MethodsData from coronary angiography performed in 2458 patients that from Department of cardiology, No 252...

Letter by Foin et al Regarding Article, “Edge Effect From Drug-Eluting Stents as Assessed With Serial Intravascular Ultrasound: A Systematic Review”

We read with great interest the article by Wakabayashi et al1 recently published in Circulation: Cardiovascular Interventions . Wakabayashi et al reviewed the mechanisms of edge restenosis, bringing insights into the possible underlying causes of this phenomenon analyzing results from several drug-eluting stent (DES) trials. They suggest that the principal mechanism of edge restenosis in bare metal stent as in DES is through plaque shift and intimal hyperplasia proliferation beyond the stent edges, within the first millimeter from the stent. Interestingly, the authors noted from several trials, including paclitaxel-, sirolimus-, zotarolimus-, and everolimus-eluting stents that despite significant reduction in restenosis with DES compared with bare metal stent control, …

Response to Letter Regarding Article, “Edge Effect From Drug-Eluting Stents as Assessed With Serial Intravascular Ultrasound: A Systematic Review”

We appreciate the letter from Drs Foin, Davies, and Di Mario and their favorable summary of our article.1 As they note, our review on stent edge restenosis focused …

TCT-247 Incidence and Characterization of Stent Dissections in Women Versus Men: A Report from the Massachusetts General Hospital Optical Coherence Tomography Registry

Background: We hypothesized that women are more prone to develop coronary dissections during PCI due to potential balloon over-sizing or gender specific plaque or vascular characteristics. To date, such a difference in edge dissection has not been systematically studied. Methods: The MGH OCT Registry is an international registry of patients undergoing PCI. We identified 206 patients (159 men, 47 women) with stable angina or acute coronary syndrome with adequate OCT images for gender specific comparison in areas of non-overlapping stents. Presence of proximal/distal edge dissections, characteristics of dissections, underlying plaque composition at stent borders and luminal diameters were assessed and compared. A multivariate logistic regression model was applied to determine if female gender was independently predictive of coronary dissection after adjusting for clinical and OCT characteristics. Results: Women had smaller mean reference vessel diameter (2.89 mm vs 3.07 mm, p 0.04) when compared to men. No gender difference was observed in age, clinical characteristics, presentation, stents per patient or plaque characteristics. Incidence and characteristics of edge dissections were different in women compared to men (Table1). These data showed that female gender (OR: 2.3, p 0.02) was an independent predictor of coronary dissection. Hypertension (OR: 2.1, p 0.03), plaque calcification at distal edge (OR: 4.6 p 0.02), lipid rich plaque at proximal edge (OR: 3.1 p 0.01) and lipid rich plaque at distal edge (OR: 3.4, p 0.01) were independently associated with the development of stent edge dissection.

TCT-297 Stent edge dissections detected by Optical Coherence Tomography, incidence, predictors and 12-month outcome

TCT-297 Stent edge dissections detected by Optical Coherence Tomography, incidence, predictors and 12-month outcome