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Edge dissection assessed in patients with drug-eluting stents
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Researchers have determined the incidence of and predictive factors for edge dissections in patients who received drug-eluting stents from 2004 to 2006.
“Drug-eluting stent implantation strategies differ from bare-metal stents and include gentler pre-dilation, more limited use of debulking devices, treatment of more complex lesions and covering the lesion ‘from normal-to-normal’ resulting in use of longer stents,” the researchers wrote. “However, the question of whether this strategy impacts on the occurrence of stent edge dissections has not been well studied.”
Data indicated that edge dissections occurred in 82 of 877 patients who underwent drug-eluting stent implantation or 9.2% of the 977 implantations performed on native arteries. About half of the dissections occurred in proximal (42 of 82; 51.2%) and about half in distal (40 of 82; 48.8%) stent edges.
Using multivariable, conditional logistic regression analysis, the researchers determined that residual plaque eccentricity (OR=1.4; P=.02), lumen-to-stent-edge-area ratio (OR=0; P=.007) and stent edge symmetry (OR=1.2; P=.02 for each 0.01 increase) were each independently associated with edge dissection and were larger among patients who experienced dissection compared with those who did not (P<.0001).
“Dissection in less diseased reference segments more often evolved into an intramural hematoma,” the researchers wrote.
Lui X. JACC Cardiovasc Interv. 2009;2:997-1004.