What is the clinical evidence from this study?

Study design: Observational. Population: Chronic total occlusions (CTO) treated with drug-eluting stents (n=105). Intervention: CTO-PCI vs. Non-CTO lesions with total stent length >24 mm. Primary outcome: Covered struts assessed by OCT (p=<0.001).

January 1, 2016

Delayed coverage of drug-eluting stents after interventional revascularisation of chronic total occlusions assessed by optical coherence tomography: the ALSTER-OCT-CTO registry

Q: What are the key findings of this study?

CTO-PCI was associated with significantly delayed drug-eluting stent coverage compared to non-CTO lesions (68.9% vs. 89.6% covered struts, p<0.001) as assessed by optical coherence tomography.

Q: What does this research mean for the field?

Percutaneous coronary intervention for chronic total occlusions (CTO-PCI) is associated with significantly delayed drug-eluting stent coverage compared to non-CTO lesions. Novelty: ClaimNovelty.INCREMENTAL. Consensus alignment: ConsensusAlignment.NEUTRAL.

Key Result

CTO-PCI was associated with significantly delayed drug-eluting stent coverage compared to non-CTO lesions (68.9% vs. 89.6% covered struts, p<0.001) as assessed by optical coherence tomography.

Study Design

Type

Observational (n=105)

Structured PICO

Does PCI with DES for chronic total occlusions result in delayed stent coverage compared to non-CTO lesions as assessed by OCT?

Population

105 patients (111 lesions) with clinically driven follow-up angiography after percutaneous coronary intervention (PCI) with drug-eluting stents (DES) who received an optical coherence tomography (OCT) analysis. The comparative analysis included 19 patients (20 lesions) with successful CTO-PCI and 28 patients (28 lesions) with non-CTO lesions and total stent length >24 mm.

Intervention

Percutaneous coronary intervention (PCI) with drug-eluting stents (DES) for chronic total occlusions (CTO)

Comparator

PCI with DES for non-CTO lesions with total stent length >24 mm

Outcome

Stent strut coverage and apposition assessed by optical coherence tomography (OCT), including percentage of covered, uncovered apposed, and uncovered malapposed struts, and neointimal thicknesssurrogate

CTO-PCI is associated with significantly delayed DES coverage compared to non-CTO PCI, providing a mechanistic rationale for the increased risk of stent thrombosis and suggesting a potential need for prolonged dual antiplatelet therapy.

Main Result

Absolute Event Rate: 68.9% vs 89.6%

p-value: p=<0.001

Abstract

AIMS: Following percutaneous coronary interventions (PCI) for revascularisation of chronic total occlusions (CTO) patients are at increased risk for stent thrombosis (ST). Delayed drug-eluting stent (DES) coverage has previously been shown to be related to ST. Using optical coherence tomography (OCT), we tested the hypothesis that CTO-PCI is associated with delayed DES coverage compared to non-CTO lesions. METHODS AND RESULTS: From 06/2010 to 11/2013, 105 patients (111 lesions) with clinically driven follow-up angiography after PCI with DES received an OCT analysis. Patients with successful CTO-PCI (19 patients/20 lesions, 6.5±2.1 months post PCI) were included in the CTO group, and patients with non-CTO lesions and total stent length >24 mm (28 patients/28 lesions, 4.9±2.2 months post PCI) were used as a control group. Struts were analysed by OCT (CTO vs. control, mean±SD): covered: 68.9±21.9% vs. 89.6±10.4%, p<0.001; uncovered apposed: 20.2±16.2% vs. 7.5±8.7%, p=0.001; uncovered malapposed: 10.9±10.3% vs. 2.9±2.6%, p<0.001. Neointimal thickness was 92.0±61.2 m vs. 109.3±39.2 m, p=0.033. No differences concerning different CTO-PCI approaches were found. CONCLUSIONS: A significantly delayed DES coverage after CTO-PCI was observed. Given the known increased rate of ST following CTO-PCI and the known association between delayed DES coverage and ST, OCT may aid in determining the optimal duration of dual antiplatelet therapy after CTO-PCI.

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