Intravascular Ultrasound Assessment of the Incidence and Predictors of Edge Dissections After Drug-Eluting Stent Implantation

ObjectivesWe used intravascular ultrasound (IVUS) to assess incidence, predictors, morphology, and angiographic findings of edge dissections after drug-eluting stent (DES) implantation.BackgroundDES implantation strategies differ compared with bare-metal stenting; coronary dissections after DES implantation have not been well studied.MethodsWe studied 887 patients with 1,045 non–in-stent restenosis lesions in 977 native arteries undergoing DES implantation with IVUS imaging.ResultsEighty-two dissections were detected; 51.2% (42 of 82) involved the proximal and 48.8% (40 of 82) the distal stent edge. Residual plaque area (8.0 ± 4.3 mm2 vs. 5.2 ± 3.0 mm2, p < 0.0001); plaque burden (52.2 ± 11.7% vs. 36.2 ± 15.3%, p < 0.0001); plaque eccentricity (8.4 ± 5.5 vs. 4.0 ± 3.4, p < 0.0001); and stent edge symmetry (1.2 ± 0.1 vs. 1.1 ± 0.1, p = 0.02) were larger; plaque burden ≥50% was more frequent (62.0% vs. 17.2%, p < 0.0001); calcium deposits (52.1% vs. 35.2%, p = 0.03) more common; and lumen-to-stent-edge-area ratio (0.9 ± 0.2 vs. 1.0 ± 0.2, p < 0.0001) was smaller in the edge dissection group compared with the nondissection group. Intramural hematomas occurred in 34.1% (28 of 82) of dissections. When compared with nonhematoma dissections, residual plaque and media area (6.4 ± 2.5 mm2 vs. 8.9 ± 4.6 mm2, p = 0.04) was smaller, and stent edges less asymmetric (1.1 ± 0.1 vs. 1.2 ± 0.1, p = 0.009) in the dissection with hematoma group. Independent predictors of any stent edge dissection were residual plaque eccentricity (odds ratio [OR]: 1.4, p = 0.02), lumen-to-stent-edge-area ratio (OR: 0.0, p = 0.007), and stent edge symmetry (OR: 1.2, p = 0.02 for each 0.01 increase).ConclusionsIVUS identified edge dissections after 9.2% of DES implantations. Residual plaque eccentricity, lumen-to-stent-edge-area ratio, and stent edge symmetry predicted coronary stent edge dissections. Dissections in less diseased reference segments more often evolved into an intramural hematoma.