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Erschienen in: Herz 1/2022

24.04.2021 | Original Article

Is coronary artery tortuosity a predisposing factor for drug-eluting stent restenosis?

verfasst von: Fatih Levent, MD, Oktay Senoz, MD, Assoc. Prof. Sadık Volkan Emren, Zeynep Yapan Emren, MD, Rahman Bilal Gediz, MD

Erschienen in: Herz | Ausgabe 1/2022

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Abstract

Background

Coronary artery tortuosity (CAT) is a relatively common finding on coronary angiography and may be associated with impaired left ventricular relaxation and coronary ischemia However, the significance of CAT remains unknown. This study aimed to investigate whether the severity of tortuosity in the targeted coronary segment is a predictor of stent restenosis.

Methods

The study included a total of 637 patients undergoing drug-eluting stent implantation due to stable or unstable angina and who had no native coronary artery stenosis on their last coronary angiogram. The patients were separated into two groups: 312 patients with in-stent restenosis and 325 patients without in-stent restenosis. All patients underwent computed tomography (CT) coronary angiography after invasive angiography and CAT was calculated using the computer software.

Results

Patients with in-stent restenosis had higher CAT than those without restenosis (1.25 ± 0.11 vs. 1.11 + 0.07, p < 0.001). Multivariate Cox regression analysis showed that the tortuosity index (hazard ratio [HR]: 1.246 95% confidence interval [CI]: 1.127–1.376 p < 0.001) and the circumflex lesion (HR: 1.437 95% CI: 1.062–1.942 p = 0.019) were independently associated with in-stent restenosis. With the threshold value of severe tortuosity set at 1.15, the prediction of could be made with 81% sensitivity and 80% specificity.

Conclusion

The severity of tortuosity is proportional to coronary in-stent stenosis in patients with stable and unstable angina pectoris undergoing drug-eluting stent implantation for a severe single coronary artery.
Literatur
2.
Zurück zum Zitat Buccheri D, Piraino D, Andolina G, Cortese B (2016) Understanding and managing in-stent restenosis: a review of clinical data, from pathogenesis to treatment. J Thorac Dis 8(10):1150–1162CrossRef Buccheri D, Piraino D, Andolina G, Cortese B (2016) Understanding and managing in-stent restenosis: a review of clinical data, from pathogenesis to treatment. J Thorac Dis 8(10):1150–1162CrossRef
3.
Zurück zum Zitat Cassese S, Byrne RA, Tada T, Pinieck S, Joner M, Ibrahim T, King LA, Fusaro M, Laugwitz KL, Kastrati A (2014) Incidence and predictors of restenosis after coronary stenting in 10 004 patients with surveillance angiography. Heart 100:153–159CrossRef Cassese S, Byrne RA, Tada T, Pinieck S, Joner M, Ibrahim T, King LA, Fusaro M, Laugwitz KL, Kastrati A (2014) Incidence and predictors of restenosis after coronary stenting in 10 004 patients with surveillance angiography. Heart 100:153–159CrossRef
4.
Zurück zum Zitat Zegers ES, Meursing BT, Zegers EB, Oude Ophuis AJ (2007) Coronary tortuosity: a long and winding road. Neth Heart J 15:191–195CrossRef Zegers ES, Meursing BT, Zegers EB, Oude Ophuis AJ (2007) Coronary tortuosity: a long and winding road. Neth Heart J 15:191–195CrossRef
5.
Zurück zum Zitat Turgut O, Yilmaz A, Yalta K, Yilmaz BM, Ozyol A et al (2007) Tortuosity of coronary arteries: an indicator for impaired left ventricular relaxation? Int J Cardiovasc Imaging 23:671–677CrossRef Turgut O, Yilmaz A, Yalta K, Yilmaz BM, Ozyol A et al (2007) Tortuosity of coronary arteries: an indicator for impaired left ventricular relaxation? Int J Cardiovasc Imaging 23:671–677CrossRef
6.
Zurück zum Zitat Jakob M, Spasojevic D, Krogmann ON, Wiher H, Hug R et al (1996) Tortuosity of coronary arteries in chronic pressure and volume overload. Cathet Cardiovasc Diagn 38:25CrossRef Jakob M, Spasojevic D, Krogmann ON, Wiher H, Hug R et al (1996) Tortuosity of coronary arteries in chronic pressure and volume overload. Cathet Cardiovasc Diagn 38:25CrossRef
7.
Zurück zum Zitat Kuntz RE, Baim DS (1993) Defining coronary restenosis. Newer clinical and angiographic paradigms. Circulation 88:1310–1323CrossRef Kuntz RE, Baim DS (1993) Defining coronary restenosis. Newer clinical and angiographic paradigms. Circulation 88:1310–1323CrossRef
8.
Zurück zum Zitat Knuuti J, Wijns W, Saraste A, Copadanno D et al (2020) 2019 ESC Guidelines for the diagnosis and management of chronic coronary syndromes: The Task Force for the diagnosis and management of chronic coronary syndromes of the European Society of Cardiology (ESC). Eur Heart J 41(3):418. https://doi.org/10.1093/eurheartj/ehz425CrossRef Knuuti J, Wijns W, Saraste A, Copadanno D et al (2020) 2019 ESC Guidelines for the diagnosis and management of chronic coronary syndromes: The Task Force for the diagnosis and management of chronic coronary syndromes of the European Society of Cardiology (ESC). Eur Heart J 41(3):418. https://​doi.​org/​10.​1093/​eurheartj/​ehz425CrossRef
9.
Zurück zum Zitat Levine GN, Bates ER, Blankenship JC et al (2012) 2011 ACCF/AHA/SCAI Guideline for Percutaneous Coronary Intervention: executive summary: a report of the American College of Cardiology Foundation/American Heart Association Task Force on Practice Guidelines and the Society for Cardiovascular Angiography and Interventions. Catheter Cardiovasc Interv 79:453–495. https://doi.org/10.1002/ccd.23438CrossRefPubMed Levine GN, Bates ER, Blankenship JC et al (2012) 2011 ACCF/AHA/SCAI Guideline for Percutaneous Coronary Intervention: executive summary: a report of the American College of Cardiology Foundation/American Heart Association Task Force on Practice Guidelines and the Society for Cardiovascular Angiography and Interventions. Catheter Cardiovasc Interv 79:453–495. https://​doi.​org/​10.​1002/​ccd.​23438CrossRefPubMed
10.
Zurück zum Zitat Morris SA, Orbash DB, Geva T, Singh MN, Gauvreau K, Lacro RV (2011) Increased vertebral artery tortuosity index is associated with adverse outcomes in children and young adults with connective tissue disorders. Circulation 124:388–396CrossRef Morris SA, Orbash DB, Geva T, Singh MN, Gauvreau K, Lacro RV (2011) Increased vertebral artery tortuosity index is associated with adverse outcomes in children and young adults with connective tissue disorders. Circulation 124:388–396CrossRef
11.
Zurück zum Zitat Duraiswamy N, Jayachandran B, Byrne J, Moore JE, Schoephoerster RT (2005) Spatial distribution of platelet deposition in stented arterial models under physiologic flow. Ann Biomed Eng 33(12):1767–1777CrossRef Duraiswamy N, Jayachandran B, Byrne J, Moore JE, Schoephoerster RT (2005) Spatial distribution of platelet deposition in stented arterial models under physiologic flow. Ann Biomed Eng 33(12):1767–1777CrossRef
12.
Zurück zum Zitat Komiyama H, Takano M, Hata N et al (2015) Neoatherosclerosis: coronary stents seal atherosclerotic lesions but result in making a new problem of atherosclerosis. World J Cardiol 7(11):776–783CrossRef Komiyama H, Takano M, Hata N et al (2015) Neoatherosclerosis: coronary stents seal atherosclerotic lesions but result in making a new problem of atherosclerosis. World J Cardiol 7(11):776–783CrossRef
13.
Zurück zum Zitat Ostermann H, van de Loo J (1986) Factors of the hemostatic system in diabetic patients. A survey of controlled studies. Haemostasis 16:386–416PubMed Ostermann H, van de Loo J (1986) Factors of the hemostatic system in diabetic patients. A survey of controlled studies. Haemostasis 16:386–416PubMed
17.
Zurück zum Zitat Li Y, Feng Y, Genshan M, Shen C, Liu N (2018) Coronary tortuosity is negatively correlated with coronary atherosclerosis. j Int Med Res 46(12):5205–5209CrossRef Li Y, Feng Y, Genshan M, Shen C, Liu N (2018) Coronary tortuosity is negatively correlated with coronary atherosclerosis. j Int Med Res 46(12):5205–5209CrossRef
18.
Zurück zum Zitat Vorobtsova N, Chiastra C, Stremler MA et al (2016) Effects of vessel tortuosity on coronary hemodynamics: an idealized and patient-specific computational study. Ann Biomed Eng 44:2228–2239CrossRef Vorobtsova N, Chiastra C, Stremler MA et al (2016) Effects of vessel tortuosity on coronary hemodynamics: an idealized and patient-specific computational study. Ann Biomed Eng 44:2228–2239CrossRef
19.
Zurück zum Zitat Chung WS, Park CS, Seung KB et al (2008) The incidence and clinical impact of stent strut fractures developed after drug-eluting stent implantation. Int J Cardiol 125:325–331CrossRef Chung WS, Park CS, Seung KB et al (2008) The incidence and clinical impact of stent strut fractures developed after drug-eluting stent implantation. Int J Cardiol 125:325–331CrossRef
20.
Zurück zum Zitat Umeda H, Gochi T, Iwase M, Izawa H, Shimizu T, Ishiki R, Inagaki H, Toyama J, Yokota M, Murohara T (2009) Frequency, predictors and outcome of stent fracture after sirolimus-eluting stent implantation. Int J Cardiol 133:321–326CrossRef Umeda H, Gochi T, Iwase M, Izawa H, Shimizu T, Ishiki R, Inagaki H, Toyama J, Yokota M, Murohara T (2009) Frequency, predictors and outcome of stent fracture after sirolimus-eluting stent implantation. Int J Cardiol 133:321–326CrossRef
21.
Zurück zum Zitat Minami Y, Ong DS, Uemura S, Wang Z, Aguirre AD, Mukhopadhyay S et al (2015) Impacts of lesion angle on incidence and distribution of acute vessel wall injuries and strut malapposition after drug-eluting stent implantation assessed by optical coherence tomography. Eur Heart J 16(12):1390–1398 Minami Y, Ong DS, Uemura S, Wang Z, Aguirre AD, Mukhopadhyay S et al (2015) Impacts of lesion angle on incidence and distribution of acute vessel wall injuries and strut malapposition after drug-eluting stent implantation assessed by optical coherence tomography. Eur Heart J 16(12):1390–1398
Metadaten
Titel
Is coronary artery tortuosity a predisposing factor for drug-eluting stent restenosis?
verfasst von
Fatih Levent, MD
Oktay Senoz, MD
Assoc. Prof. Sadık Volkan Emren
Zeynep Yapan Emren, MD
Rahman Bilal Gediz, MD
Publikationsdatum
24.04.2021
Verlag
Springer Medizin
Erschienen in
Herz / Ausgabe 1/2022
Print ISSN: 0340-9937
Elektronische ISSN: 1615-6692
DOI
https://doi.org/10.1007/s00059-021-05036-z

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