Late loss of lumen after PCI

Late loss of lumen after PCI

Abstract: Minimal luminal diameter (MLD) at the end of the procedure minus the minimal luminal diameter at the repeat angiogram, generally at 6 months is taken as the late loss of lumen after PCI.

The gain in lumen immediately after a percutaneous intervention is known as the acute gain. Acute gain is defined as the difference between the minimal luminal diameter before the procedure and after the procedure. Angiograms in multiple projections are needed to measure the minimal luminal diameter because all coronary stenoses are not perfectly circular or symmetric. Most stenoses are in fact eccentric rather than concentric. Late lumen loss is correlated with binary restenosis [1].

Part of the gain may be lost in the long run due to neo-endothelial proliferation and this is known as the late lumen loss after PCI. Late lumen loss at follow up angiogram is an important parameter assessed in clinical trials assessing the use of coronary stents and bioresorbable vascular scaffolds [2]. Though a study showed similar clinical outcomes at two years, those treated with bioresorbable vascular scaffold had significantly lower two year in-stent/scaffold minimal luminal diameter compared to the patients treated with everolimus eluting stents [2].

The authors suggested appropriately powered randomized trial to confirm the exploratory results of their study and to assess the prognostic and clinical significance.

References

  1. Laura Mauri, E John Orav, A James O’Malley, Jeffrey W Moses, Martin B Leon, David R Holmes Jr, Paul S Teirstein, Joachim Schofer, Günter Breithardt, Donald E Cutlip, Dean J Kereiakes, Chunxue Shi, Brian G Firth, Dennis J Donohoe, Richard E Kuntz. Relationship of late loss in lumen diameter to coronary restenosis in sirolimus-eluting stents. Circulation. 2005 Jan 25;111(3):321-7.
  2. Yao-Jun Zhang, Christos V Bourantas, Takashi Muramatsu, Javaid Iqbal, Vasim Farooq, Roberto Diletti, Carlos A M Campos, Yoshinobu Onuma, Hector M Garcia-Garcia, Patrick W Serruys. Comparison of acute gain and late lumen loss after PCI with bioresorbable vascular scaffolds versus everolimus-eluting stents: an exploratory observational study prior to a randomised trial. EuroIntervention. 2014 Oct;10(6):672-80.