Tissue responses to everolimus-eluting stents implanted in severely calcified lesions following atherectomy

Figures

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  Fig. 1. Representative paired cross-section of frequency-domain optical coherence tomography images at baseline and follow-up. a–c Classification of malapposed struts on background plaque morphology at baseline. a Malapposed strut on fractured calcium or calcium modified with atherectomy device (modified calcium; mod-Ca); a malapposed strut on fractured calcium (Ca-Fx; red arrow); b: malapposed strut on calcium modified with atherectomy device (A-Ca; red arrow). b Malapposed strut on calcium without fracture or modification with atherectomy (non-mod-Ca; red arrows). c Malapposed struts on non-calcium tissue (non-Ca; red arrows). d–g Matched struts with resolved acute stent malposition and neointimal coverage at follow-up (blue arrows)

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  Fig. 2. Representative paired cross-sectional images of BP-EES and DP-EES. a Cross-sectional image of implanted BP-EES at baseline. Red arrow indicated a malapposed strut of Mod-Ca. b Cross-sectional image of implanted BP-EES at follow-up. Adequate vascular healing was observed (blue arrow). c Cross-sectional image of implanted DP-EES at baseline. Red arrow indicated a malapposed strut of Non-Ca. d Cross-sectional image of implanted DP-EES at follow-up. Resolution of stent malapposition was not observed (blue arrow)

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  Fig. 3. The estimated effect of calcium modification and stent selection to predict the adequate vascular healing using multivariate linear regression analysis via generalized estimated equation. Continuous variables were employed to estimate adequate vascular healing as 1-standard deviation (SD) increase in this model. The SDs for each parameter in malapposed struts were 114 days for follow-up duration, 141 μm for S–V distance, and 2.91 mm2 for cross-sectional lumen area. BP-EES biodegradable polymer everolimus-eluting stent, DP-EES durable polymer everolimus-eluting stent, mod-Ca modified calcium, non-mod-Ca non-modified calcium, non-Ca non-calcium, S–V distance stent–vessel lumen distance

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  Fig. 4. Effect modification model predicting adequate vascular healing of plaque morphologies and stent type using regression analysis via generalized estimating equation, adjusting for follow-up duration, S–V distance, and cross-sectional lumen area. Adequate vascular healing was significantly associated with stent type and plaque morphology behind the struts, comparing DP-EES with non-mod-Ca as reference (BP-EES on mod-Ca: OR 10.312, 95% CI 2.211–48.090, P = 0.003; BP-EES on non-Ca: OR 4.620, 95% CI 0.885–24.114, P = 0.069; BP-EES on non-mod-Ca: OR 3.710, 95% CI 0.629–21.877, P = 0.148; DP-EES on mod-Ca: OR 2.860, 95% CI 1.226–6.672, P = 0.015; DP-EES on non-Ca: OR 1.249, 95% CI 0.357–4.374, P = 0.728; P for interaction = 0.004)