Skip to main content
SpringerLink
Log in

Comparison of the performance of zotarolimus- and everolimus-eluting stents by optical coherence tomography and coronary angioscopy

  • Original Article
  • Published:
Heart and Vessels Aims and scope Submit manuscript

Abstract

Overall stent performance should be characterized by geometric luminal gain acquisition, neointimal coverage of the stent struts, and stabilization of the underlying inflammatory neoatheroma. The aim of this study was to compare the performance of zotarolimus-eluting stent (ZES), everolimus-eluting stent (EES) and bare metal stent (BMS) using optical coherence tomography (OCT) and coronary angioscopy. For 36 stented coronary lesions (BMS, 12 lesions; ZES, 11 lesions; EES, 13 lesions) in 27 patients, we calculated neointimal area and uncovered stent strut rate based on OCT findings at 10 months after stent placement. The grades of neointimal coverage and yellow color, both of which were classified from 0 to 3, were also assessed by coronary angioscopy. The plaque area of the ZES lesions was larger than that of the EES lesions (P < 0.05) but smaller than that of the BMS lesions (P < 0.05). The OCT-based uncovered rate of the ZES lesions was less than that of the EES lesions (P < 0.01), but similar to that of the BMS lesions. The stent coverage grade by angioscopy was higher in the ZES lesions than in the EES lesions (P < 0.05), but similar to the BMS lesions. The yellow grade was less in the ZES lesions than in the EES lesions (P < 0.01), but similar to the BMS lesions. ZES might be better than BMS in terms of neointimal thickening, and better than EES in terms of neointimal coverage as well as prevention of neoatheroma formation. ZES may have superior performance compared with EES.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2
Fig. 3
Fig. 4

Similar content being viewed by others

References

  1. Poon M, Marx SO, Gallo R, Badimon JJ, Taubman MB, Marks AR (1996) Rapamycin inhibits vascular smooth muscle cell migration. J Clin Invest 1998:2277–2283

    Article  Google Scholar 

  2. Costa M, Simon D (2005) Molecular basis of restenosis and drug-eluting stents. Circulation 111:2257–2273

    Article  PubMed  Google Scholar 

  3. Inoue T, Node K (2009) Molecular basis of restenosis and novel issues of drug-eluting stents. Circ J 73:615–621

    Article  CAS  PubMed  Google Scholar 

  4. Rogers C, Parikh S, Scifert P, Edelman E (1996) Endogenous cell seeding: remnant endothelium after stenting enhances vascular repair. Circulation 94:2909–2914

    Article  CAS  PubMed  Google Scholar 

  5. Inoue T, Croce K, Morooka T, Sakuma M, Node K, Simon DI (2011) Vascular inflammation and repair: implication for reendothelialization, restenosis, and stent thrombosis. JACC Cardiovasc Interv 4(10):1057–1066

    Article  PubMed  PubMed Central  Google Scholar 

  6. Farb A, Burke AP, Kolodgie FD, Virmani R (2003) Pathological mechanisms of fetal late coronary stent thrombosis in humans. Circulation 108:1701–1706

    Article  PubMed  Google Scholar 

  7. Alfonso F, Suárez A, Pérez-Vizcayno MJ, Moreno R, Escaned J, Bañuelos C, Jiménez P, Bernardo E, Angiolillo DJ, Hernández R, Macaya C (2007) Inravascular ultraaound findings during episodes of drug-eluting stent thrombosis. J Am Coll Cardiol 50:2095–2097

    Article  PubMed  Google Scholar 

  8. Cook S, Wenaweser P, Togni M, Billinger M, Morger C, Seiler C, Vogel R, Hess O, Meier B, Windecker S (2007) Incomplete stent apposition and very late stent thrombosis after drug-eluting stent inplantation. Circulation 115:2426–2434

    Article  CAS  PubMed  Google Scholar 

  9. Taguchi I, Yoneda S, Abe S, Toyoda S, Nasuno T, Nishino S, Kageyama M, Tokura M, Ogawa M, Node K, Inoue T (2014) The late phase inflammatory response after drug-eluting stent implantation. Heart Vessels 29:213–219

    Article  PubMed  Google Scholar 

  10. Nakazawa G, Otsuka F, Nakano M, Vorpahl M, Yazdani SK, Ladich E, Kolodgie FD, Finn AV, Virmani R (2011) The pathology of neoatherosclerosis in human coronary implants bare-metal and drug-eluting stents. J Am Coll Cardiol 57:1314–1322

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  11. Akazawa Y, Matsuo K, Ueda Y, Nishio M, Hirata A, Asai M, Nemoto T, Wada M, Murakami A, Kashiwase K, Kodama K (2014) Atherosclerotic change at one year after implantation of Endeavor zotarolimus-eluting stent vs. everolimus-eluting stent. Circ J 78:1428–1436

    Article  PubMed  Google Scholar 

  12. Nasuno T, Kageyama M, Toyoda S, Sakuma M, Komatsu T, Taguchi I, Abe S, Inoue T (2015) The wound healing response after implantation of a drug-eluting stent is impaired persistently in the long-term. Heart Vessels. doi:10.1007/s00380-015-0676-y

    PubMed Central  Google Scholar 

  13. Haase J, Escand J, van Swijndregt EM, Ozaki Y, Gronenschild E, Slager CJ, Serruys PW (1993) Experimental validation of geometrical and densitometric measurements on the new generation coronary angiography analysis system (CAAS II). Cathet Cariovasc Diagn 30:104–114

    Article  CAS  Google Scholar 

  14. Mastumoto D, Shite J, Shinke T, Otake H, Tanino Y, Ogasawara D, Sawada T, Paredes OL, Hirata K, Yokoyama M (2007) Neointimal coverage of sirolimus-eluting stents at 6 months follow-up: evaluated by optical coherence tomography. Eur Heart J 28:961–967

    Article  Google Scholar 

  15. Ishigami K, Uemura S, Morikawa Y, Soeda T, Okayama S, Nishida T, Takemoto Y, Onoue K, Somekawa S, Takeda Y, Kawata H, Horii M, Saito Y (2009) Long term follow-up of neointimal coverage of sirolimus-eluting stent: evaluation with optical coherence tomography. Circ J 73:2300–2307

    Article  PubMed  Google Scholar 

  16. Kotani J, Awata M, Nanto S, Uematsu M, Oshima F, Minamiguchi H, Mintz GS, Nagata S (2006) Incomplete neointimal coverage of sirolimus-eluting stents. J Am Coll Cardiol 47:2108–2111

    Article  CAS  PubMed  Google Scholar 

  17. Awata M, Kotani J, Uematsu M, Morozumi T, Watanabe T, Onishi T, Iida O, Sera F, Nanto S, Hori M, Nagata S (2007) Serial angioscopic evidence of neointimal coverage after sirolimus-eluting stents implantation: comparison with bare-metal stents. Circulation 116:910–916

    Article  CAS  PubMed  Google Scholar 

  18. Awata M, Nanto S, Uematsu M, Morozumi T, Watanabe T, Onishi T, Iida O, Sera F, Minamiguchi H, Kotani J, Nagata S (2009) Heterogeneous arterial healing in patients following paclitaxel-eluting stent implantation. JACC Cardiovasc Interv 2:453–458

    Article  PubMed  Google Scholar 

  19. Kandzari DE, Mauri L, Popma JJ, Turco MA, Gurbel PA, Fitzgerald PJ, Leon MB (2011) Late-term clinical outcomes with zotarolimus- and sirolimus-eluting stents: 5-year follow-up of the ENDEAVOR III (a randomized controlled trial of the Medtronic Endeavor drug [ABT-578] eluting coronary stent system versus the Cypher sirolimus-eluting coronary stent system in de novo native coronary artery lesions). JACC Cardiovasc Interv 4:543–550

    Article  PubMed  Google Scholar 

  20. Leon MB, Mauri L, Popma JJ, Cutlip DE, Nikolsky E, O’Shaughnessy C, Overlie PA, McLaurin BT, Solomon SL, Douglas John S, Jr JS, Ball MW, Caputo RP, Jain A, Tolleson TR, Reen BM III, Kirtane AJ, Fitzgerald PJ, Thompson K, Kandzari DE, ENDEAVOR IV Investigators (2010) A randomized comparison of the Endeavor zotarolimus-eluting stent versus the TAXUS paclitaxel-eluting stent in de novo native coronary lesions: 12-month outcomes from the ENDEAVOR IV trial. J Am Coll Cardiol 55:543–554

    Article  CAS  PubMed  Google Scholar 

  21. Gada H, Kirtane AJ, Newman W, Sanz M, Hermiller JB, Mahaffey KW, Cutlip DE, Sudhir K, Hou L, Koo K, Stone GW (2013) 5-year results of a randomized comparison of XIENCE V everolimus-eluting and TAXUS paclitaxel-eluting stents: final results from the SPIRIT III Trial (clinical evaluation of the XIENCE V everolimus eluting coronary stent system in the treatment of patients with de novo native coronary artery lesions). JACC Cardiovasc Interv 6:1263–1266

    Article  PubMed  Google Scholar 

  22. Chen KY, Rha SW, Wang L, Li YJ, Li GP, Poddar KL, Park JY, Choi CU, Park CG, Seo HS, Oh DJ, Jeong MH, Ahn YK, Hong TJ, Kim YJ, Hur SH, Seong IW, Chae JK, Cho MC, Bae JH, Choi DH, Jang YS, Chae IH, Kim CJ, Yoon JH, Chung WS, Seung KB, Park SJ, KAMIR Investigators (2012) Unrestricted use of 2 new-generation drug-eluting stents in patients with acute myocardial infarction a propensity score-matched analysis. JACC Cardiovasc Interv 5:936–945

    Article  PubMed  Google Scholar 

  23. Omar A, Torguson R, Kitabata H, Pendyala LK, Loh JP, Magalhaes MA, Satler LF, Suddath WO, Pichard AD, Waksman R (2014) Long-term safety and efficacy of second-generation everolimus-eluting stent compared to other limus-eluting stents and bare metal stents in patients with acute coronary syndrome. Catheter Cardiovasc Interv 84:1053–1060

    Article  PubMed  Google Scholar 

  24. Miyamoto A, Prieto AR, Friedl SE, Lin FC, Muller JE, Nesto RW, Abela GS 2nd (2004) Atheromatous plaque cap thickness can be determined by quantitative color analysis during angioscopy: implications for identifying the vulnerable plaque. Clin Cardiol 27:9–15

    Article  PubMed  Google Scholar 

  25. Ishibashi F, Lisauskas JB, Kawamura A, Waxman S (2008) Topographic association of angioscopic yellow plaques with coronary atherosclerotic plaque: assessment with quantitative colorimetry in human coronary artery autopsy specimen. Int J Cardiovasc Imaging 24:1–5

    Article  PubMed  Google Scholar 

  26. Ueda Y (2014) Intracoronary imaging of in-stent atherosclerosis by coronary angioscopy and optical coherence tomography. Circ J 76:61–62

    Article  Google Scholar 

  27. Ta Taniwaki M, Stefanini GG, Silber S, Richard G, Vranckx P, Serruys PW, Buszman PE, Kelback H, Windecker S (2014) 4-year clinical outcome and predictors of repeat revascularization in patients treated with new generation drug-eluting stents: a report from the RESOLUTE All-Comers trial (A Randomized Comparison of a Zotarolimus-Eluting Stent With an Everolimus-Eluting Stent for Percutaneous Coronary Intervention). J Am Coll Cardiol 63:1617–1625

    Article  Google Scholar 

  28. Gutiérrez-Chico JL, van Geuns RJ, Regar E, van der Giessen WJ, Kelbæk H, Saunamäki K, Escaned J, Gonzalo N, di Mario C, Borgia F, Nüesch E, García-García HM, Silber S, Windecker S, Serruys PW (2011) Tissue coverage of a hydrophilic polymer-coated zotarolimus-eluting stent vs. a fluoropolymer-coated everolimus-eluting stent at 13-month follow-up: an optical coherence tomography substudy from the RESOLUTE All Comers trial. Eur Heart J 32:2454–2463

    Article  PubMed  PubMed Central  Google Scholar 

  29. Kim JS, Kim BK, Jang IK, Shin DH, Ko YG, Choi D, Hong MK, Cho YK, Nam CW, Hur SH, Choi JH, Song YB, Hahn JY, Choi SH, Gwon HC, Jang Y (2012) ComparisOn of neointimal coVerage betwEen zotaRolimus-eluting stent and everolimus-eluting stent using Optical Coherence Tomography (COVER OCT). Am Heart J 163:601–607

    Article  PubMed  Google Scholar 

  30. Yoneda S, Abe S, Taguchi I, Masawa N, Inoue K, Inoue T (2012) Inflammation and impaired wound healing after zotarolimus-eluting stent implantation. Cardiovasc Pathol 21:511–514

    Article  PubMed  Google Scholar 

Download references

Acknowledgments

We thank Ms. Ayumi Matsunuma, Ms. Mayumi Kofuji and Ms. Noriko Ogawara for their secretarial assistance. This work was supported in part by a Grant-in-Aid for Scientific Research from the Ministry of Education, Science and Culture of Japan (22590794) and by the Vehicle Racing Commemorative Foundation, Tokyo, Japan.

Author information

Authors and Affiliations

  1. Department of Cardiovascular Medicine, Dokkyo Medical University School of Medicine, 880 Kitakobayashi, Mibu, Tochigi, 321-0293, Japan

    Taito Masawa, Shichiro Abe, Shigeru Toyoda, Masashi Sakuma, Takahisa Nasuno, Michiya Kageyama, Michiaki Tokura, Satoshi Koizumi & Teruo Inoue

  2. Department of Cardiology, Koshigaya Hospital, Dokkyo Medical University School of Medicine, Koshigaya, Japan

    Isao Taguchi

Authors
  1. Taito Masawa
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Shichiro Abe
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Shigeru Toyoda
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Masashi Sakuma
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Takahisa Nasuno
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Michiya Kageyama
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Michiaki Tokura
    View author publications

    You can also search for this author in PubMed Google Scholar

  8. Satoshi Koizumi
    View author publications

    You can also search for this author in PubMed Google Scholar

  9. Isao Taguchi
    View author publications

    You can also search for this author in PubMed Google Scholar

  10. Teruo Inoue
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Shichiro Abe.

Ethics declarations

Conflict of interest

The authors declare that there is no conflict of interest.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Masawa, T., Abe, S., Toyoda, S. et al. Comparison of the performance of zotarolimus- and everolimus-eluting stents by optical coherence tomography and coronary angioscopy. Heart Vessels 31, 1230–1238 (2016). https://doi.org/10.1007/s00380-015-0728-3

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00380-015-0728-3

Keywords

Search

Navigation