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권지은,이왕수,Gary S. Mintz,홍영준,이성윤,김기석,한주용,Kaup Sharath Kumar,원호연,현승협,신승용,이광제,김태호,김치정,김상욱 대한심장학회 2016 Korean Circulation Journal Vol.46 No.4
Background and Objectives: We assessed plaque erosion of culprit lesions in patients with acute coronary syndrome in real world practice. Subjects and Methods: Culprit lesion plaque rupture or plaque erosion was diagnosed with optical coherence tomography (OCT). Intravascular ultrasound (IVUS) was used to determine arterial remodeling. Positive remodeling was defined as a remodeling index (lesion/ reference EEM [external elastic membrane area) >1.05. Results: A total of 90 patients who had plaque rupture showing fibrous-cap discontinuity and ruptured cavity were enrolled. 36 patients showed definite OCT-plaque erosion, while 7 patients had probable OCT-plaque erosion. Overall, 26% (11/43) of definite/probable plaque erosion had non-ST elevation myocardial infarction (NSTEMI) while 35% (15/43) had ST elevation myocardial infarction (STEMI). Conversely, 14.5% (13/90) of plaque rupture had NSTEMI while 71% (64/90) had STEMI (p<0.0001). Among plaque erosion, white thrombus was seen in 55.8% (24/43) of patients and red thrombus in 27.9% (12/43) of patients. Compared to plaque erosion, plaque rupture more often showed positive remodeling (p=0.003) with a larger necrotic core area examined by virtual histology (VH)-IVUS, while negative remodeling was prominent in plaque erosion. Overall, 65% 28/43 of plaque erosions were located in the proximal 30 mm of a culprit vessel-similar to plaque ruptures (72%, 65/90, p=0.29). Conclusion: Although most of plaque erosions show nearly normal coronary angiogram, modest plaque burden with negative remodeling and an uncommon fibroatheroma might be the nature of plaque erosion. Multimodality intravascular imaging with OCT and VH-IVUS showed fundamentally different pathoanatomic substrates underlying plaque rupture and erosion.
Hong, Myeong-Ki,Mintz, Gary S,Lee, Cheol Whan,Park, Duk-Woo,Choi, Bong-Ryong,Park, Kyoung-Ha,Kim, Young-Hak,Cheong, Sang-Sig,Song, Jae-Kwan,Kim, Jae-Joong,Park, Seong-Wook,Park, Seung-Jung W.B. Saunders [etc.] 2006 European heart journal Vol.27 No.11
<P>AIMS: In many countries, drug-eluting stent implantation is the dominant interventional strategy. We evaluated the clinical, angiographic, procedural, and intravascular ultrasound (IVUS) predictors of angiographic restenosis after sirolimus-eluting stent (SES) implantation. METHODS AND RESULTS: SES implantation was successfully performed in 550 patients with 670 native coronary lesions. Six-month follow-up angiography was performed in 449 patients (81.6%) with 543 lesions (81.1%). Clinical, angiographic, procedural, and IVUS predictors of restenosis were determined. Using multivariable logistic regression analysis, the only independent predictors of angiographic restenosis were post-procedural final minimum stent area by IVUS [odds ratio (OR)=0.586, 95% confidence interval (CI) 0.387-0.888, P=0.012] and IVUS-measured stent length (OR=1.029, 95% CI 1.002-1.056, P=0.035). Final minimum stent area by IVUS and IVUS-measured stent length that best separated restenosis from non-restenosis were 5.5 mm2 and 40 mm, respectively. Lesions with final minimum stent area<5.5 mm2 and stent length>40 mm had the highest rate of angiographic restenosis [17.7% (11/62)], P<0.001 compared with other groups. CONCLUSION: Independent predictors of angiographic restenosis after SES implantation were post-procedural final minimum stent area by IVUS and IVUS-measured stent length. The angiographic restenosis rate was highest in lesions with stent area<5.5 mm2 and stent length>40 mm.</P>
Late target lesion revascularization after implantation of sirolimus-eluting stent
Hong, Myeong-Ki,Mintz, Gary S.,Lee, Cheol Whan,Park, Duk-Woo,Lee, Seung-Whan,Kim, Young-Hak,Jung, In-Hyun,Kim, Sang-Hyun,Cheong, Sang-Sig,Kim, Jae-Joong,Park, Seong-Wook,Park, Seung-Jung Wiley Subscription Services, Inc., A Wiley Company 2008 CATHETERIZATION AND CARDIOVASCULAR INTERVENTIONS Vol.71 No.3
<P>Objectives: We evaluated the incidence, clinical presentation, and angiographic in-stent restenosis (ISR) pattern of late target lesion revascularization (TLR) after sirolimus-eluting stent (SES) implantation. Background: Late TLR is an unusual finding beyond 6–9 months after bare-metal stent implantation. However, late TLR after SES implantation has not been sufficiently evaluated. Methods: The study population consisted of 804 patients with 1,020 native lesions that were patent at 6-month follow-up angiogram after SES implantation. Results: Late TLR was performed in 18 patients with 18 lesions (1.8%) at 24.1 ± 2.6 months (range; 18–30 months) after SES implantation. Clinical presentation of late TLR patients was silent ischemia in eight patients and recurrent angina in 10 patients, but none had an acute coronary syndrome. Angiographic ISR pattern of late TLR lesions were focal ISR in 12 lesions (67%) and diffuse ISR in six lesions (33%). Serial quantitative coronary angiographic analysis of these lesions showed a minimal lumen diameter of 2.6 ± 0.5 mm immediately after SES implantation, 2.4 ± 0.4 mm at 6-month follow-up and 0.7 ± 0.6 mm at 24-month follow-up (ANOVA P < 0.001). By stepwise multiple logistic regression analysis, the only independent predictor of late TLR was stent length (P < 0.001, OR = 1.040, 95% CI = 1.019–1.061). Conclusions: Late TLR was performed in 1.8% of 1,020 native lesions that were patent at 6-month follow-up angiogram. Clinical presentations of late TLR was either silent ischemia or recurrent angina, but not acute coronary syndrome. Two-thirds of late TLR lesions had a focal angiographic ISR pattern. © 2007 Wiley-Liss, Inc.</P>
Hong, Myeong-Ki,Mintz, Gary S.,Lee, Cheol Whan,Park, Duk-Woo,Park, Kyoung-Min,Lee, Bong-Ki,Kim, Young-Hak,Song, Jong-Min,Han, Ki-Hoon,Kang, Duk-Hyun,Cheong, Sang-Sig,Song, Jae-Kwan,Kim, Jae-Joong,Park Ovid Technologies Wolters Kluwer -American Heart A 2006 CIRCULATION - Vol.113 No.3
<P>BACKGROUND: Late stent malapposition (LSM) after drug-eluting stent (DES) implantation has not been evaluated sufficiently in real-world practice. METHODS AND RESULTS: We evaluated the incidence, mechanisms, predictors, and long-term prognosis of LSM after DES implantation in 557 patients (705 native lesions; sirolimus-eluting stent in 538 lesions and paclitaxel-eluting stent in 167 lesions) in whom intravascular ultrasound was performed at index and 6-month follow-up. LSM occurred in 82 patients with 85 lesions (12.1% overall, 95% CI 9.7% to 14.5%, 71 lesions (13.2%) in sirolimus-eluting stents and 14 lesions [8.4%] in paclitaxel-eluting stents, P=0.12]; the incidence was 25.0% (4/16) after directional coronary atherectomy before stenting, 27.5% (14/51) in chronic total occlusion lesions, and 31.8% (7/22) after primary stenting in acute myocardial infarction (P=0.13, P<0.001, and P=0.001, respectively, versus elective stenting with conventional balloon predilation, 9.7% [60/616]). There was an increase of external elastic membrane area (from 17.1+/-3.6 to 21.4+/-4.8 mm2, P<0.001) that was greater than the increase in plaque area (from 9.3+/-2.5 to 10.5+/-2.7 mm2, P<0.001). Independent predictors of LSM were total stent length, primary stenting in acute myocardial infarction, and chronic total occlusion lesions. Except for 1 death in the non-LSM group, there were no major adverse cardiac events in either LSM or non-LSM patients during a mean 10-month follow-up after detection of LSM. CONCLUSIONS: LSM occurs in 12% of cases after DES implantation. The predictors of LSM are total stent length, primary stenting in acute myocardial infarction, and chronic total occlusion lesions. LSM after DES implantation was not associated with any major adverse cardiac events during a subsequent 10-month (mean) follow-up.</P>
Long-term Clinical Outcomes of Drug-Eluting Stent Malapposition
Seung-Yul Lee,Gary S. Mintz,Jung-Sun Kim,Byeong-Keuk Kim,Yangsoo Jang,Myeong-Ki Hong 대한심장학회 2020 Korean Circulation Journal Vol.50 No.10
Previous pathologic, intravascular imaging, and clinical studies have investigated the association between adverse cardiac events and stent malapposition, including acute stent malapposition (ASM, that is detected at index procedure) and late stent malapposition (LSM, that is detected during follow-up) that can be further classified into late-persistent stent malapposition (LPSM, ASM that remains at follow-up) or late-acquired stent malapposition (LASM, newly developed stent malapposition at follow-up that was not present immediately after index stent implantation). ASM has not been associated with adverse cardiac events compared with non-ASM, even in lesions with large-sized malapposition. The clinical outcomes of LSM may depend on its subtype. The recent intravascular ultrasound studies with long-term follow-up have consistently demonstrated that LASM steadily increased the risk of thrombotic events in patients with first-generation drug-eluting stents (DESs). This association has not yet been identified in LPSM. Accordingly, it is reasonable that approaches to stent malapposition should be based on its relationship with clinical outcomes. ASM may be tolerable after successful stent implantation, whereas prolonged anti-thrombotic medications and/or percutaneous interventions to modify LASM may be considered in selected patients with first-generation DESs. However, these treatments are still questionable due to lack of firm evidences.
Kang, Soo-Jin,Mintz, Gary S.,Akasaka, Takashi,Park, Duk-Woo,Lee, Jong-Young,Kim, Won-Jang,Lee, Seung-Whan,Kim, Young-Hak,Whan Lee, Cheol,Park, Seong-Wook,Park, Seung-Jung Ovid Technologies Wolters Kluwer -American Heart A 2011 CIRCULATION - Vol.123 No.25
<P>We report findings from optical coherence tomography (OCT) of in-stent neoatherosclerosis as a cause of drug-eluting stent (DES) failure.</P>
Shin, Dong-Ho,Hong, Sung-Jin,Mintz, Gary S.,Kim, Jung-Sun,Kim, Byeong-Keuk,Ko, Young-Guk,Choi, Donghoon,Jang, Yangsoo,Hong, Myeong-Ki American College of Cardiology 2016 JACC. Cardiovascular interventions Vol.9 No.21
<P>CONCLUSIONS Compared with angiographic guidance, IVUS-guided new-generation DES implantation was associated with favorable outcomes in terms of major adverse cardiac events, the composite of cardiac death, myocardial infarction, or stent thrombosis. These findings must be interpreted only for complex lesions, because all identified patients had long lesions or chronic total occlusions.</P>