Evaluation of Below-the-Knee Drug-Eluting Stents With Frequency-Domain Optical Coherence Tomography:.

Evaluation of Below-the-Knee Drug-Eluting Stents With Frequency-Domain Optical Coherence Tomography:.

J Endovasc Ther. 2013 Feb;20(1):80-93

Authors: Paraskevopoulos I, Spiliopoulos S, Davlouros P, Karnabatidis D, Katsanos K, Alexopoulos D, Siablis D

Abstract
Purpose : To report the use of intravascular frequency-domain optical coherence tomography (FD-OCT) to detect and characterize in-stent neointimal tissue following infrapopliteal drug-eluting stent (DES) placement in patients suffering from critical limb ischemia. Methods : This prospective study included 12 patients (7 men; mean age 72.8�7.2 years) who had previously received 21 infrapopliteal sirolimus- or everolimus-eluting stents. The patients returned for regular angiographic follow-up or presented with clinical relapse of symptoms over a mean follow-up of 13.5�7.3 months (range 6-33), at which time FD-OCT imaging was performed. Study endpoints were technical imaging success, defined as successful FD-OCT acquisition and visualization of the arterial lumen and complete vessel wall, and the detection and characterization of in-stent neointimal hyperplasia according to widely accepted OCT criteria. Results : OCT imaging was successfully completed in 19 of the 21 stents. Binary in-stent restenosis (ISR>50%) was detected in 10/19 stents. Percent restenosis was higher after longer follow-up (60.6%�19.8% ?1 year vs. 35.3%�20.6% <1 year, p=0.03) and in symptomatic vs. asymptomatic patients (61.5%�20.4% vs. 37.2%�19.3%, p=0.04). Neoatherosclerosis findings included lipid-laden neointima (16/19), neointimal neovascularization (13/19), neointimal calcifications (6/19), and thrombus (5/19); no cases of thin-cap fibroatheroma were identified. Neointimal calcifications were more frequent after ?12 months of follow-up compared to <12 months (46.6% vs. 0%, p=0.02). Conclusion : FD-OCT of the infrapopliteal arteries following DES placement is safe and feasible and may demonstrate features of developing neointimal neoatherosclerosis. The latter might play a key role as a mechanism of below-the-knee ISR and warrants further investigation.

PMID: 23391087 [PubMed - in process]

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