Coronary Imaging

(Abstract nos. AS-132–AS-144

AS-132

Relationship between Tissue Prolapse and Arterial Healing afterSES Implantation following Cutting Balloon Angioplasty: AnOptical Coherence Tomography Analysis. Kenichi Komukai,Masato Mizukoshi, Hironori Kitabata, Atsushi Tanaka,Takashi Kubo, Shigeho Takarada, Kumiko Hirata, Keizou Kimura,Yasushi Ino, Takashi Tanimoto, Kohei Ishibashi, Kazushi Takemoto,Toshio Imanishi, Takashi Akasaka. Wakayama Medical University,Wakayama, Japan.

Background: Sirolimus-eluting stents (SES) are frequently implantedfollowing cutting balloon angioplasty (CB) for in-stent restenosis (ISR)with large neointimal hyperplasia. Coronary stent deployment is oftenassociated with tissue prolapse, and it can cause such complications asacute occlusion. However, what effect tissue prolapse can have onarterial healing has not been fully elucidated. Optical coherence to-mography (OCT) is a high-resolution imaging modality and allows usto analyze vascular response after stenting in detail. The purpose of thisstudy was to evaluate the relationship between tissue prolapse andarterial healing by OCT.

Methods: We evaluated the degree of tissue prolapse in 31 patientswith stable angina pectoris after stent implantation. The patients weredivided into 2 groups: 1) the CB (�) group—SES implantation fol-lowing CB for the in-stent restenosis group (n � 15); 2) the CB (�)group—SES implantation without CB group (n � 16). We measuredtissue prolapse area and stent cross-sectional area (CSA) by OCT at thesite of maximal tissue prolapse immediately after the procedure andanalyzed stent apposition and neointimal coverage at a 9-month follow-up.

Results: The ratio of tissue prolapse area to stent CSA wassignificantly greater in the CB (�) group than in CB (�) group(0.116 � 0.046 vs 0.067 � 0.018, p � 0.009). However, there wasno significant difference in the ratio of stent CSA to reference lumenCSA between groups: CB (�) group 1.235 � 0.202, CB (�) group1.431 � 0.279. At 9-month follow-up, incomplete stent appositionwas observed more frequently in CB (�) group than in CB (�)group (malapposed struts per lesion 4.76 � 1.08% vs 3.46 � 1.27%,p � 0.034). Furthermore, peristrut ulcer like appearance were seenmore frequently in CB (�) group than in CB (�) group (75.0% vs7.7% of patients, p � 0.001), and thrombus was observed around theperistrut ulcer. The average rate of neointima-uncovered struts in anindividual SES was greater in CB (�) group than in CB (�) group(8.8% vs 4.5%).

Conclusion: Compared with SES implantation without CB, SESimplantation following CB was associated with greater tissue prolapseimmediately after stent implantation and resulted in late stent malap-position, although similar stent expansion was obtained in both groups.Although arterial healing may be delayed after SES implantation withCB, these findings were not associated with stent thrombosis in patientswith antiplatelet therapy.

AS-133Computed Tomography Coronary Angiography in HemodialysisPatients. Teppei Sugaya, Takayoshi Yamaguchi, Jungo Furuya,Yasumi Igarashi, Keiichi Igarashi. Hokkaido Social InsuranceHospital, Sapporo, Japan.

Background: In general, it is said that the evaluation of stenosis bycomputed tomography coronary angiography (CTCA) is difficult inhemodialysis (HD) patients who frequently have calcified lesions. Theaim of this study was to evaluate the clinical usefulness of CTCA inHD patients.

Methods: We consecutively performed 1401 cases of 64-sliceCTCA in 2008. Among them, we analyzed 1309 cases (non-HD: 1229cases; HD: 80 cases), except for cases of motion artifact.

Results: The underlying disease in HD patients was diabetes mel-litus (DM; 51.3 %), chronic glomerulonephritis (CGN; 22.5 %), other(8.9 %), or unclear (17.5 %). We could not evaluate the stenosis forcalcification at 1 or more segments in 135 non-HD patients (11.0 %)and in 31 HD patients (38.8 %). In HD patients, although there was nosignificant difference in the underlying disease or age, there weresignificant differences in duration of HD between evaluable cases andunevaluable cases (total: � 68.8 months vs 123.3 � 93.6 months; DM:49.3 � 43.6 months vs 106.3 � 96.3 months; CGN: 85.2 � 109.5months vs 140.5 � 98.1 months). We could compare CTCA withcoronary angiography in 20 HD patients. If we considered unevaluablelesions for calcification as stenosis, the accuracy of CTCA in HDpatients was 93% in clinically important vessels.

Conclusion: In this study, the degree of the calcification of coro-nary arteries related to the duration of HD significantly. Although thereare several limitation to assessing stenosis in calcified lesion, CTCAmay be useful with HD patients in real clinical practice.

AS-134Comparison of Culprit Lesions of Stable Angina and AcuteCoronary Syndrome with Multidetector Computed Tomography.So Yeon Kim, Myeung Joon Seung, Young Soo Lee, Jin Bae Lee,Jae Kean Ryu, Ji Young Choi, Sung-Gug Chang. Daegu CatholicUniversity Hospital, Daegu, Republic of Korea.

Background: Disruption of coronary artery plaque is the primarycause of acute coronary syndrome (ACS). The vulnerable, rupture-prone plaques are characterized by large lipid cores with thin fibrouscaps, positive remodeling, and small coronary calcium. Recently, mul-tidetector computed tomography (MDCT) has been known to charac-terize the coronary artery plaques. We studied the difference of culpritlesions between ACS and stable angina pectoris (SAP) using multide-tector computed tomography (MDCT)

Methods: Sixty-four-slice MDCT was conducted in 59 patients, 26patients of whom had ACS and 33 SA before percutaneous coronaryintervention (PCI). The culprit coronary lesions were evaluated forsignal intensity (SI) of plaque presenting as Hounsfield units (HU),spotty calcification, outer vessel diameter, and area in culprit andreference lesion. The remodeling index (RI) was defined as the ratio oflesion diameter and mean of proximal and distal reference diameter.

Results: In patients with ACS, culprit coronary lesions had signif-icantly higher RI than patients with SAP (1.14 � 1.19 vs 0.91 � 0.30,p � 0.001). The plaque of culprit coronary lesions in patients with ACSwere less calcified (3.8% vs 36.4%, p � 0.008). The mean SI of plaqueswas significantly lower in ACS patients (38.39 � 22.35HU vs 89.16 �43.45HU, p � 0.000) In addition, more spotty calcification was ob-served in patients with ACS (93.8% vs 23.8%, p � 0.001). Receiveroperator characteristic (ROC) curves showed discrimination betweenSAP and ACS with 53.3 HU of SI (sensitivity of 80.6%, specificity of76.9%, and an area of 0.822), and 1.05 of RI (sensitivity of 73.1%,

The American Journal of Cardiology� APRIL 28–30 2010 ANGIOPLASTY SUMMIT ABSTRACTS/E-Poster 57B

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ABSTRACTS

Wednesday, April 28 - Friday, April 30, 2010 (E-Poster Abstract Zone)