Healthy Strut Coverage After Coronary Stent Implantation: An Ex Vivo Human Autopsy Study
| Autor: | Masayuki Mori, Atsushi Sakamoto, Yu Sato, Kazuyuki Yahagi, Rika Kawakami, Sho Torii, Rahul R Bhoite, Anne Cornelissen, Renu Virmani, Hiroyuki Jinnouchi, Fumiyuki Otsuka, Aloke V. Finn, Frank D. Kolodgie |
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| Rok vydání: | 2020 |
| Předmět: |
Male
medicine.medical_specialty Platelet aggregation medicine.medical_treatment Autopsy Coronary Artery Disease 030204 cardiovascular system & hematology 03 medical and health sciences 0302 clinical medicine Percutaneous Coronary Intervention Optical coherence tomography Re-Epithelialization Predictive Value of Tests Neointima Coronary stent medicine Humans Registries 030304 developmental biology Aged 0303 health sciences medicine.diagnostic_test business.industry Percutaneous coronary intervention Endothelial Cells Middle Aged equipment and supplies Coronary Vessels Treatment Outcome Female Stents Radiology Cardiology and Cardiovascular Medicine business Ex vivo Tomography Optical Coherence |
| Zdroj: | Circulation. Cardiovascular interventions. 13(5) |
| ISSN: | 1941-7632 |
| Popis: | Background: Struts have been considered as covered when tissue overlying the struts is >0 μm by optical coherence tomography (OCT). However, there is no confirmatory study to validate this definition by histology which is the gold standard. The aim of the present study was to assess the appropriate cutoff value of neointimal thickness of stent strut coverage by OCT with histology confirmation. Methods: We performed ex vivo OCT imaging of human coronary arteries with stents at autopsy. A total of 46 stents in 39 vessels from 25 patients were examined in this study, and a total of 165 cross-sectional images were co-registered with histology to determine the optimal cutoff value for strut coverage by OCT which was defined as luminal endothelial cells with 2 abluminal layers of smooth muscles cells and matrix. Considering the resolution of OCT is 10 to 20 μm, the cutoff values were assessed at ≥20, ≥40, and ≥60 μm. Results: A total of 2235 struts were reviewed by histology, 1216 were considered as well-matched struts which were analyzed in this study. By histology, 160 struts were identified as uncovered, while 1056 struts were covered. The OCT assessment without consideration of neointimal thickness yielded a poor specificity of 37.5% and sensitivity 100%. Of 3 cutoff values, the cutoff value of ≥40 μm yielded the best sensitivity (99.3%), specificity (91.0%), positive predictive value (98.6%), and negative predictive value (95.6%) as compared with ≥20 and ≥60 μm. Conclusions: Neointimal thickness ≥40 μm by OCT yielded the most accurate cutoff value to identify stent strut coverage validated by histology. |
| Databáze: | OpenAIRE |
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