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Comparison of neointimal coverage and extra-stent lumen between sirolimus and everolimus-eluting stent using optical coherence tomography

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Abstract

The external lumen of a stent [defined as extra-stent lumen (ESL)] assessed by optical coherence tomography (OCT) may be related to the risk of thrombus formation after sirolimus-eluting stent (SES) implantation. An everolimus-eluting stent (EES) might provide relatively minimal inflammatory reaction and appropriate neointimal coverage. The purpose of this study was to compare the neointimal thickness and ESL between SES and EES. Patients who underwent OCT examination more than 7 months after either SES or EES implantation were enrolled. Stent area (SA), lumen area (LA), neointimal area (NIA) and neointimal thickness (NIT) of each strut were measured at 1-mm intervals between stented segments. The area, angle (summation per cross-section) and depth (maximum distance from adjacent vessel surface to the outline of stent) of ESL were analyzed. A total of 49 lesions were included (SES n = 20, EES n = 29). Mean follow-up period was 11 months. A total of 998 cross-sections and 9874 struts were analyzed. There were no differences in stent area, lumen area and neointimal area (SA: 6.01 ± 1.60 vs. 6.02 ± 1.40 mm2, p = 0.572, LA: 5.37 ± 1.52 vs. 5.29 ± 1.34 mm2, p = 0.692, NIA: 0.64 ± 0.49 vs. 0.72 ± 0.37 mm2, p = 0.493). Mean NIT of SES and EES were 0.11 ± 0.05 and 0.10 ± 0.05 mm, respectively (p = 0.367). Conversely, area, angle and depth of ESL in SES group were significantly greater than those in EES group (0.20 ± 0.39 vs. 0.03 ± 0.09 mm2, p < 0.001, 56.2 ± 59.1° vs. 20.1 ± 41.9°, p < 0.001, 0.10 ± 0.09 vs. 0.03 ± 0.03 mm, p < 0.001). OCT showed that the efficacy of neointimal growth suppression is similar between SES and EES, whereas the adverse vascular response after EES implantation is smaller than that after SES implantation.

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References

  1. Daemen J, Serruys PW (2007) Drug-eluting stent update 2007: part I. A survey of current and future generation drug-eluting stents: meaningful advances or more of the same? Circulation 116:316–328

    Article  PubMed  Google Scholar 

  2. Finn AV, Joner M, Nakazawa G, Kolodgie F, Newell J, Gold HK, John MC, Virmani R (2007) Pathological correlates of late drug-eluting stent thrombosis: strut coverage as a marker of endothelialization. Circulation 115:2435–2441

    Article  PubMed  Google Scholar 

  3. Leong DP, Dundon BK, Puri R, Yeend RA (2008) Very late stent fracture associated with a sirolimus-eluting stent. Heart Lung Circ 17:426–428

    Article  CAS  PubMed  Google Scholar 

  4. Joner M, Finn AV, Farb A, Mont EK, Kolodgie FD, Ladich E, Kutys R, Skorija K, Gold HK, Virmani R (2006) Pathology of drug-eluting stents in humans: delayed healing and late thrombotic risk. J Am Coll Cardiol 48:193–202

    Article  PubMed  Google Scholar 

  5. Virmani R, Guagliumi G, Farb A (2004) Localized hypersensitivity and late coronary thrombosis secondary to a sirolimus-eluting stent. Should we be cautious? Circulation 109:701–705

    Article  PubMed  Google Scholar 

  6. Otsuka Y, Nakamura M, Kokubu N, Tonooka A, Inoue K, Higami T (2012) Diffuse in-stent restenosis of CYPHER stent due to hypersensitivity reaction confirmed by pathohistological findings. Heart Vessels 27:110–113

    Article  PubMed  Google Scholar 

  7. Nakazawa G, Finn AV, Vorpahl M, Ladich ER, Kolodgie FD, Virmani R (2011) Coronary responses and differential mechanisms of late stent thrombosis attributed to first-generation sirolimus- and paclitaxel-eluting stents. J Am Coll Cardiol 57:390–398

    Article  CAS  PubMed  Google Scholar 

  8. Stone GW, Midei M, Newman W, Sanz M, Hermiller JB, Williams J, Farhat N, Mahaffey KW, Cutlip DE, Fitzgerald PJ, Sood P, Su X, Lansky AJ (2008) Comparison of an everolimus-eluting stent and a paclitaxel-eluting stent in patients with coronary artery disease: a randomized trial. JAMA 299:1903–1913

    Article  CAS  PubMed  Google Scholar 

  9. Kim BK, Hong MK, Shin DH, Nam CM, Kim JS, Ko YG, Choi D, Kang TS, Park BE, Kang WC, Lee SH, Yoon JH, Hong BK, Kwon HM, Jang Y, RESET Investigators (2012) A new strategy for discontinuation of dual antiplatelet therapy: the RESET Trial (REal Safety and Efficacy of 3-month dual antiplatelet Therapy following Endeavor zotarolimus-eluting stent implantation). J Am Coll Cardiol 60:1340–1348

    Article  CAS  PubMed  Google Scholar 

  10. Park KW, Chae I-H, Lim D-S, Han KR, Yang HM, Lee HY, Kang HJ, Koo BK, Ahn T, Yoon JH, Jeong MH, Hong TJ, Chung WY, Jo SH, Choi YJ, Hur SH, Kwon HM, Chun DW, Kim BO, Park SH, Lee NH, Jeon HK, Gwon HC, Jang YS, Kim HS (2011) Everolimus-eluting versus sirolimus-eluting stents in patients undergoing percutaneous coronary interventions: the EXCELLENT (efficacy of xience/promus versus cypher to reduce late loss after stenting) randomized trial. J Am Coll Cardiol 58:1844–1854

    Article  CAS  PubMed  Google Scholar 

  11. Park DW, Kim YH, Song HG, Ahn JM, Kim WJ, Lee JY, Kang SJ, Lee SW, Lee CW, Park SW, Yun SC, Seung KB, Yang TH, Lee SG, Lee JH, Seong IW, Cheong SS, Lee BK, Lee NH, Lee SW, Lee SW, Lee K, Kim HS, Jeon DS, Kim MK, Nah DY, Tahk SJ, Park SJ (2011) Comparison of everolimus- and sirolimus-eluting stents in patients with long coronary artery lesions: a randomized LONG-DES-III (percutaneous treatment of LONG native coronary lesions with drug-eluting stent-III) Trial. JACC Cardiovasc Interv 4:1096–1103

    Article  PubMed  Google Scholar 

  12. Jensen LO, Thayssen P, Hansen HS, Christiansen EH, Tilsted HH, Krusell LR, Villadsen AB, Junker A, Hansen KN, Kaltoft A, Maeng M, Pedersen KE, Kristensen SD, Bøtker HE, Ravkilde J, Sanchez R, Aarøe J, Madsen M, Sørensen HT, Thuesen L, Lassen JF (2012) Randomized comparison of everolimus-eluting and sirolimus-eluting stents in patients treated with percutaneous coronary intervention: the Scandinavian organization for randomized trials with clinical outcome IV (SORT OUT IV). Circulation 125:1246–1255

    Article  PubMed  Google Scholar 

  13. Ikuta S, Kobuke K, Iwanaga Y, Nakauchi Y, Yamaji K, Miyazaki S (2014) Difference in neointimal coverage at chronic stage between bare metal stent and sirolimus-eluting stent evaluated at stent-strut level by optical coherence tomography. Heart Vessels 29:320–327

    Article  PubMed  Google Scholar 

  14. Kume T, Akasaka T, Kawamoto T, Watanabe N, Toyota E, Sukmawan R, Sadahira Y, Yoshida K (2005) Visualization of neointima formation by optical coherence tomography. Int Heart J 46:1133–1136

    Article  PubMed  Google Scholar 

  15. Di Mario C, Barlis P (2008) Optical coherence tomography: a new tool to detect tissue coverage in drug-eluting stents. JACC Cardiovasc Interv 1:174–175

    Article  PubMed  Google Scholar 

  16. Tada T, Kadota K, Hosogi S, Kubo S, Ozaki M, Yoshino M, Miyake K, Eguchi H, Ohashi N, Hayakawa Y, Saito N, Otsuru S, Hasegawa D, Shigemoto Y, Habara S, Imai M, Tanaka H, Fuku Y, Oka N, Kato H, Yamamoto H, Fujii S, Goto T, Mitsudo K (2012) Optical coherence tomography findings in lesions after sirolimus-eluting stent implantation with peri-stent contrast staining. Circ Cardiovasc Interv 5:649–656

    Article  CAS  PubMed  Google Scholar 

  17. Radu MD, Raber L, Kalesan B, Muramatsu T, Heo J, Kelbak H, Jorgensen E, Helqvist S, Farooq V, Brugaletta S, Garcia-Garcia HM, Juni P, Saunamaki K, Windecker S, Serruys PW (2014) Coronary evaginations are associated with positive vessel remodeling and are nearly absent following implantation of newer-generation drug-eluting stents: an optical coherence tomography and intravascular ultrasound study. Eur Heart J 35:795–807

    Article  CAS  PubMed  Google Scholar 

  18. Kume T, Akasaka T, Kawamoto T, Ogasawara Y, Watanabe N, Toyota E, Neishi Y, Sukmawan R, Sadahira Y, Yoshida K (2006) Assessment of coronary arterial thrombus by optical coherence tomography. Am J Cardiol 97:1713–1717

    Article  PubMed  Google Scholar 

  19. Shibuya M, Fujii K, Fukunaga M, Imanaka T, Miki K, Tamaru H, Ohyanagi M, Masuyama T (2013) Natural history of low-intensity neointimal tissue after an everolimus-eluting stent implantation: a serial observation with optical coherence tomography. Heart Vessels. doi:10.1007/s00380-013-0450-y

    PubMed  Google Scholar 

  20. Otake H, Shite J, Ikeno F, Shinke T, Teramoto T, Miyoshi N, Ako J, Honda Y, Fitzgerald PJ, Hirata K (2012) Evaluation of the peri-strut low intensity area following sirolimus- and paclitaxel-eluting stents implantation: insights from an optical coherence tomography study in humans. Int J Cardiol 157:38–42

    Article  PubMed  Google Scholar 

  21. Alfonso F, Pérez-Vizcayno M-J, Ruiz M, Suárez A, Cazares M, Hernández R, Escaned J, Bañuelos C, Jiménez-Quevedo P, Macaya C (2009) Coronary aneurysms after drug-eluting stent implantation: clinical, angiographic, and intravascular ultrasound findings. J Am Coll Cardiol 53:2053–2060

    Article  CAS  PubMed  Google Scholar 

  22. Imai M, Kadota K, Goto T, Fujii S, Yamamoto H, Fuku Y, Hosogi S, Hirono A, Tanaka H, Tada T, Morimoto T, Shiomi H, Kozuma K, Inoue K, Suzuki N, Kimura T, Mitsudo K (2011) Incidence, risk factors, and clinical sequelae of angiographic peri-stent contrast staining after sirolimus-eluting stent implantation. Circulation 123:2382–2391

    Article  CAS  PubMed  Google Scholar 

  23. Kimura T, Morimoto T, Natsuaki M, Shiomi H, Igarashi K, Kadota K, Tanabe K, Morino Y, Akasaka T, Takatsu Y, Nishikawa H, Yamamoto Y, Nakagawa Y, Hayashi Y, Iwabuchi M, Umeda H, Kawai K, Okada H, Kimura K, Simonton CA, Kozuma K, RESET Investigators (2012) Comparison of everolimus-eluting and sirolimus-eluting coronary stents: 1-year outcomes from the randomized evaluation of sirolimus-eluting versus everolimus-eluting stent trial (RESET). Circulation 126:1225–1236

    Article  CAS  PubMed  Google Scholar 

  24. Takano M, Yamamoto M, Mizuno M, Murakami D, Inami T, Kimata N, Murai K, Kobayashi N, Okamatsu K, Ohba T, Seino Y, Mizuno K (2010) Late vascular responses from 2 to 4 years after implantation of sirolimus-eluting stents: serial observations by intracoronary optical coherence tomography. Circ Cardiovasc Interv 3:476–483

    Article  CAS  PubMed  Google Scholar 

  25. Kolandaivelu K, Swaminathan R, Gibson WJ, Kolachalama VB, Nguyen-Ehrenreich KL, Giddings VL, Coleman L, Wong GK, Edelman ER (2011) Stent thrombogenicity early in high-risk interventional settings is driven by stent design and deployment and protected by polymer-drug coatings. Circulation 123:1400–1409

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  26. Kon H, Sakai H, Otsubo M, Takano H, Okamoto K, Sato T, Kimura T, Inoue K (2011) Contrast staining outside the sirolimus-eluting stent leading to coronary aneurysm formation: a case of very late stent thrombosis associated with hypersensitivity reaction. Circ Cardiovasc Interv 4:e1–e3

    Article  PubMed  Google Scholar 

  27. Teramoto T, Ikeno F, Otake H, Lyons JK, van Beusekom HM, Fearon WF, Yeung AC (2010) Intriguing peri-strut low-intensity area detected by optical coherence tomography after coronary stent deployment. Circ J 74:1257–1259

    Article  PubMed  Google Scholar 

  28. Otake H, Shite J, Ikeno F, Shinke T, Teramoto T, Miyoshi N, Ako J, Honda Y, Fitzgerald PJ, Hirata K (2012) Evaluation of the peri-strut low intensity area following sirolimus- and paclitaxel-eluting stents implantation: insights from an optical coherence tomography study in humans. Int J Cardiol 157:38–42

    Article  PubMed  Google Scholar 

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Acknowledgments

This study was partly supported by JSPS KAKENHI Grant Number 23591045.

Conflict of interest

There are no conflicts of interests to disclose.

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Authors and Affiliations

  1. Division of Cardiology, Department of Medicine and Clinical Science, Yamaguchi University Graduate School of Medicine, 1-1-1 Minamikogushi, Ube, Yamaguchi, 755-8505, Japan

    Takamasa Oda, Takayuki Okamura, Jutaro Yamada, Tomoko Nao, Hiroki Tateishi, Takao Maeda, Takeshi Nakamura, Kohzoh Shiraishi, Tadamitsu Nakashima, Shigehiko Nishimura, Toshiro Miura, Masunori Matsuzaki & Masafumi Yano

  2. Division of Cardiology, Cardiovascular Center, Urasoe General Hospital, Urasoe, Okinawa, Japan

    Naoto Miyagi & Hiroki Uehara

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  1. Takamasa Oda
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  2. Takayuki Okamura
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Correspondence to Takayuki Okamura.

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Oda, T., Okamura, T., Yamada, J. et al. Comparison of neointimal coverage and extra-stent lumen between sirolimus and everolimus-eluting stent using optical coherence tomography. Heart Vessels 31, 449–456 (2016). https://doi.org/10.1007/s00380-015-0630-z

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  • DOI: https://doi.org/10.1007/s00380-015-0630-z

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