Original Title: Tissue Protrusion after Stent Implantation. An ADAPT-DES Intravascular Ultrasound Substudy.

Reference: Fuyu Qiu et al. J Am Coll Cardiol Intv. 2016;9(14):1499-1507.

After DES implantation we may observe tissue protrusion (plaque or thrombus) relatively often, especially in unstable lesions; however, its clinical impact has not been studied. The aim of this study was to assess long term prevalence and clinical impact of tissue protrusion after DES implantation.

The ADAPT-DES (Assessment of Dual Antiplatelet Therapy With Drug-Eluting Stents) prospectively included 8,663 patients undergoing DES stenting.

In a pre-specified intravascular ultrasound (IVUS) substudy, 2,072 patients had post stenting IVUS and were classified according to presence or absence of post stenting tissue protrusion.

After stenting, 34.3% of lesions showed tissue protrusion by IVUS. Maximum tissue protrusion was 0.7 mm2 in area (range 0.5 to 1.2 mm) and 3 mm in length (range 1.4 to 6.7 mm).

Patients with tissue protrusion were often undergoing high risk ACS (STEMI and NSTEMI) and less often unstable angina or stable ischemic cardiomyopathy.

In 893 lesions studied by IVUS prior stenting, tissue protrusion was associated with larger proximal reference lumen area, greater plaque burden, and more plaque ruptures, attenuated plaque, and VH-thin cap fibroatheromas.

Because tissue protrusion often lead to post-dilation, these patients had a larger lumen area than patients without tissue protrusion.

At two year follow up, there was less clinically driven target lesion revascularization in patients with tissue protrusion and no significant difference in incidence of major adverse cardiac events (cardiac death, MI, or stent thrombosis) in patients with vs without tissue protrusion.

Conclusion

Tissue protrusion diagnosed by IVUS after DES stenting is not associated to adverse events in the long term, partly because of greater post dilation stent expansion.

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