Intravascular ultrasound (IVUS) is used before and after intervention and at follow-up
to assess the quality of the acute result as well as the long-term effects of stent
implantation. Virtual histology (VH) IVUS classifies tissue into fibrous and fibrofatty
plaque, dense calcium, and necrotic core. Although most interventional procedures
include stent implantation, VH IVUS classification of stent metal has not been validated.
In this study, the VH IVUS appearance of acutely implanted stents was assessed in
27 patients (30 lesions). Most stent struts (80%) appeared white (misclassified as
“calcium”) surrounded by red (misclassified as “necrotic core”); 2% appeared just
white, and 17% were not detectable (compared with grayscale IVUS because of the software-imposed
gray medial stripe). The rate of “white surrounded by red” was similar over the lengths
of the stents; however, undetectable struts were mostly at the distal edges (31%).
Quantitatively, including the struts within the regions of interest increased the
amount of “calcium” from 0.23 ± 0.35 to 1.07 ± 0.66 mm2 (p <0.0001) and the amount of “necrotic core” from 0.59 ± 0.65 to 1.31 ± 0.87 mm2 (p <0.0001). Most important, because this appearance occurs acutely, it is an artifact,
and the red appearance should not be interpreted as peristrut inflammation or necrotic
core when it is seen at follow-up. In conclusion, acutely implanted stents have an
appearance that can be misclassified by VH IVUS as “calcium with or without necrotic
core.” It is important not to overinterpret VH IVUS studies of chronically implanted
stents when this appearance is observed at follow-up. A separate classification for
stent struts is necessary to avoid these misconceptions and misclassifications.
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Article info
Publication history
Published online: June 13, 2008
Accepted:
March 17,
2008
Received in revised form:
March 17,
2008
Received:
January 17,
2008
Identification
Copyright
© 2008 Elsevier Inc. Published by Elsevier Inc. All rights reserved.
