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Background: Persistent or late acquired incomplete stent apposition (ISA) may be associated with late or very late stent thrombosis following drug-eluting stent implantation. Presence of calcium at the target lesion may increase the risk of ISA even after rotational atherectomy (RA) followed by stenting with high pressure balloon inflation. The aim of this study is to examine the incidence and characteristics of ISA in heavily calcified lesions.Methods: A total of 52 heavily calcified coronary artery lesions requiring RA plus stenting were selected and studied. After successful ablation followed by stent implantation, optical coherence tomography (OCT) was performed to assess stent expansion and apposition. Presence or absence of ISA was examined and maximal stent strut to vessel wall distance (max SV distance) was measured. In lesions with repeated OCT at follow-up, serial changes in ISA were investigated.Results: ISA was documented in 51 of 52 (98%) lesions. Mean max SV distance was 713 ± 371 μm. In lesions with serial OCT images (n = 11), max SV distance decreased significantly (692.1 ± 420.2 to 462.5 ± 387.0 μm, P < 0.01) but persisted in all but 2 lesions (82%).Conclusions: ISA is frequently documented in heavily calcified lesions requiring RA. Significant ISA still persisted with minimal improvement in SV distance at follow-up. Prognostic impact of the persistent ISA in such calcified lesions needs further investigations. [ABSTRACT FROM AUTHOR]

Background: The involvement of cholesterol crystals (CCs) in plaque progression and destabilization of atherosclerotic plaques has been recently recognized. This study aimed to evaluate the association between the intraplaque localization of CCs and plaque vulnerability. Methods: We investigated 55 acute coronary syndrome (ACS) and 80 stable angina pectoris (stable AP) lesions using optical frequency domain imaging (OFDI) prior to percutaneous coronary intervention. The distance between CCs and the luminal surface of coronary plaques was defined as CC depth. Results: Although the incidence of CCs had similar frequencies in the ACS and stable AP groups (95% vs. 89%, p = 0.25), CC depth was significantly less in patients with ACS than in those with stable AP (median [25th to 75th percentile]: 68 μm [58 to 92 μm] vs. 152 μm [115 to 218 μm]; p < 0.001). The incidences of plaque rupture, thrombus, lipid-rich plaques, and thin-cap fibroatheroma were significantly greater in patients with ACS than in those with stable AP (62% vs. 18%, p < 0.001; 67% vs. 16%, p < 0.001; 84% vs. 57%, p < 0.01; and 56% vs. 19%, p < 0.001, respectively). Conclusion: OFDI analysis revealed that CCs were found in the more superficial layers within the coronary atherosclerotic plaques in patients with ACS than in those with stable AP, suggesting that CC depth is associated with plaque vulnerability. CC depth, a novel OFDI-derived parameter, could be potentially used as an alternative means of evaluating plaque vulnerability in coronary arteries. [ABSTRACT FROM AUTHOR]

Background: Coronary artery calcification is highly prevalent in patients with end-stage renal disease (ESRD) on maintenance dialysis. Calcified nodule (CN) is recognized as one of the pathogenic mechanisms of acute coronary syndrome (ACS) and the cause of under expansion after stent implantation. However, the prognostic impact of CN is unclear. The aim of this study is to examine the association between CN and major cardiovascular events (MACE) in patients with ESRD who underwent PCI. Methods: A total of 49 patients with ESRD who underwent PCI were enrolled in this study. CN was defined as distinct calcification with protruding and convex luminal shape by optical coherence tomography (OCT). MACE included all-cause death, non-fatal myocardial infarction, target vessel revascularization (TVR) and stroke. Results: CNs were observed in 29 patients (59.2%). Rotational atherectomy was more frequently used in patients with CN compared with those without CN (27.8% vs. 5.0%; p=0.0448). During a median follow-up of 826 days, all-cause death, TVR and MACE occurred in 7 (14.3%), 11 (22.4%) and 16 (32.7%) patients, respectively. Kaplan-Meier survival analysis revealed that MACE was significantly higher (44.8% vs. 15.0%; p=0.0360) and all-cause death and TVR (20.7% vs. 5.0%; p=0.1994, 31.0% vs. 10.0%; p=0.0791, respectively) tended to be higher in patients with CN compared with those without CN (Figure). Adjusted cox proportional hazards analysis demonstrated that CN was independent predictor of MACE (HR 3.56, 95% CI 1.05-16.6, p=0.0417). Conclusions: CN was associated with MACE in patients with ESRD. [ABSTRACT FROM AUTHOR]