Abstract
Data on early vascular healing response of novel stent designs are scarce. In this randomized prospective trial, we sought to compare early neointimal coverage of cobalt–chromium-based titanium–nitride–oxide-coated bioactive stents (CoCr-BAS) versus platinum–chromium everolimus-eluting stents (PtCr-EES) at 2-month follow-up in patients with acute coronary syndrome (ACS). Forty patients with ACS were randomized to receive either CoCr-BAS (n = 19) or PtCr-EES (n = 21). Neointimal strut coverage and strut apposition were examined by optical coherence tomography; and coronary flow reserve (CFR), fractional flow reserve (FFR) and index of microcirculatory resistance (IMR) were assessed using a coronary pressure wire at 2 months. Two patients in the PtCr-EES underwent OCT out of the time frame of the study, and were excluded from analysis. At 63 ± 8 days, 302 cross-sections (3412 struts) were analysed in the CoCr-BAS group, and 324 cross-sections (3460 struts) in the PtCr-EES group. Median [IQR] neointimal thickness was 203 [108] µm and 42.2 [41] µm for CoCr-BAS and PtCr-EES, respectively (p < 0.001). Median [IQR] percentage of uncovered struts was 1.2 [2.8] % versus 11.3 [17.7] %, respectively (p < 0.001). Flow measurements were comparable between the two groups (p > 0.05 for all). CoCr-BAS showed earlier and more adequate neointimal coverage of struts at 2 months, compared with PtCr-EES, but with more neointimal hyperplasia. Functional healing as assessed by CFR, FFR, and IMR was similar between the two stent arms.
Similar content being viewed by others
References
Palmerini T, Biondi-Zoccai G, Riva DDD, Stettler C, Sangiorgi D, D’Ascenzo F, Kimura T, Briguori C, Sabatè M, Kim H-S, De Waha A, Kedhi E, Smits PC, Kaiser C, Sardella G et al (2012) Stent thrombosis with drug-eluting and bare-metal stents: evidence from a comprehensive network meta-analysis. Lancet 379(9824):1393–1402
Bangalore S, Kumar S, Fusaro M, Amoroso N, Attubato MJ, Feit F, Bhatt DL, Slater J (2012) Short- and long-term outcomes with drug-eluting and bare-metal coronary stents: a mixed-treatment comparison analysis of 117 762 patient-years of follow-up from randomized trials. Circulation 125(23):2873–2891
Sarno G, Lagerqvist B, Fröbert O, Nilsson J, Olivecrona G, Omerovic E, Saleh N, Venetzanos D, James S (2012) Lower risk of stent thrombosis and restenosis with unrestricted use of “new-generation” drug-eluting stents: a report from the nationwide Swedish Coronary Angiography and Angioplasty Registry (SCAAR). Eur Heart J 33(5):606–613
Sabaté M, Brugaletta S, Cequier A, Iñiguez A, Serra A, Hernádez-Antolín R, Mainar V, Valgimigli M, Tespili M, den Heijer P, Bethencourt A, Vázquez N, Backx B, Serruys PW (2014) The EXAMINATION trial (everolimus-eluting stents versus bare-metal stents in ST-segment elevation myocardial infarction): 2-year results from a multicenter randomized controlled trial. JACC Cardiovasc Interv 7(1):64–71
Finn AV, Joner M, Nakazawa G, Kolodgie F, Newell J, John MC, Gold HK, Virmani R (2007) Pathological correlates of late drug-eluting stent thrombosis: strut coverage as a marker of endothelialization. Circulation 115(18):2435–2441
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(1):193–202
Nakazawa G, Finn AV, Joner M, Ladich E, Kutys R, Mont EK, Gold HK, Burke AP, Kolodgie FD, Virmani R (2008) Delayed arterial healing and increased late stent thrombosis at culprit sites after drug-eluting stent placement for acute myocardial infarction patients: an autopsy study. Circulation 118(11):1138–1145
Mosseri M, Tamari I, Plich M, Hasin Y, Brizines M, Frimerman A, Miller H, Jafari J, Guetta V, Solomon M, Lotan C (2005) Short- and long-term outcomes of the titanium–NO stent registry. Cardiovasc Revasc Med 6(1):2–6
Karjalainen PP, Ylitalo A, Airaksinen JK, Nammas W (2011) Five-year clinical outcome of titanium–nitride–oxide-coated bioactive stent implantation in a real-world population: a comparison with paclitaxel-eluting stents: the PORI registry. J Interv Cardiol 24(1):1–8
Tuomainen PO, Ylitalo A, Niemelä M, Kervinen K, Pietilä M, Sia J, Nyman K, Nammas W, Airaksinen KEJ, Karjalainen PP (2013) Five-year clinical outcome of titanium–nitride–oxide-coated bioactive stents versus paclitaxel-eluting stents in patients with acute myocardial infarction: long-term follow-up from the TITAX AMI trial. Int J Cardiol 168(2):1214–1219
Karjalainen PP, Niemela M, Airaksinen JKE, Rivero-Crespo F, Romppanen H, Sia J, Lalmand J, de Bruyne B, De Belder A, Carlier M, Nammas W, Ylitalo A, Hess OM (2012) A prospective randomised comparison of titanium-nitride-oxide-coated bioactive stents with everolimus-eluting stents in acute coronary syndrome: the BASE-ACS trial. EuroIntervention 8(3):306–315
Hamm CW, Bassand J-P, Agewall S, Bax J, Boersma E, Bueno H, Caso P, Dudek D, Gielen S, Huber K, Ohman M, Petrie MC, Sonntag F, Uva MS, Storey RF et al (2011) ESC guidelines for the management of acute coronary syndromes in patients presenting without persistent ST-segment elevation: The Task Force for the management of acute coronary syndromes (ACS) in patients presenting without persistent ST-segment elevatio. Eur Heart J 32(23):2999–3054
Steg PG, James SK, Atar D, Badano LP, Blömstrom-Lundqvist C, Borger MA, Di Mario C, Dickstein K, Ducrocq G, Fernandez-Aviles F, Gershlick AH, Giannuzzi P, Halvorsen S, Huber K, Juni P et al (2012) ESC Guidelines for the management of acute myocardial infarction in patients presenting with ST-segment elevation. Eur Heart J 33(20):2569–2619
Kereiakes DJ, Cox DA, Hermiller JB, Midei MG, Bachinsky WB, Nukta ED, Leon MB, Fink S, Marin L, Lansky AJ (2003) Usefulness of a cobalt chromium coronary stent alloy. Am J Cardiol 92(4):463–466
Prati F, Cera M, Ramazzotti V, Imola F, Giudice R, Albertucci M (2007) Safety and feasibility of a new non-occlusive technique for facilitated intracoronary optical coherence tomography (OCT) acquisition in various clinical and anatomical scenarios. EuroIntervention 3(3):365–370
Pijls NNHJ, De Bruyne B, Smith L, De Bruyne B, Aarnoudse W, Barbato E, Bartunek J, Bech GJW, Van De, Vosse F (2002) Coronary thermodilution to assess flow reserve validation in humans. Circulation 105(21):2482–2486
Kim S, Kim J-S, Shin D-H, Kim B-K, Ko Y-G, Choi D, Cho Y-K, Nam C-W, Hur S-H, Jang Y, Hong M-K (2013) Comparison of early strut coverage between zotarolimus- and everolimus-eluting stents using optical coherence tomography. Am J Cardiol 111(1):1–5
Karjalainen P, Kiviniemi TO, Lehtinen T, Nammas W, Ylitalo A, Saraste A, Mikkelsson J, Pietila M, Biancari F, Airaksinen JKE (2013) Neointimal coverage and vasodilator response to titanium–nitride–oxide-coated bioactive stents and everolimus-eluting stents in patients with acute coronary syndrome: insights from the BASE-ACS trial. Int J Cardiovasc Imaging 29(8):1693–1703
Silber S, Kirtane AJ, Belardi JA, Liu M, Brar S, Rothman M, Windecker S (2014) Lack of association between dual antiplatelet therapy use and stent thrombosis between 1 and 12 months following resolute zotarolimus-eluting stent implantation. Eur Heart J 35(29):1949–1956
Guagliumi G, Capodanno D, Ikejima H, Bezerra HG, Sirbu V, Musumeci G, Fiocca L, Lortkipanidze N, Vassileva A, Tahara S, Valsecchi O, Costa MA (2013) Impact of different stent alloys on human vascular response to everolimus-eluting stent: an optical coherence tomography study: the OCTEVEREST. Catheter Cardiovasc Interv 81(3):510–518
Stone GW, Teirstein PS, Meredith IT, Farah B, Dubois CL, Feldman RL, Dens J, Hagiwara N, Allocco DJ, Dawkins KD (2011) A prospective, randomized evaluation of a novel everolimus-eluting coronary stent: the PLATINUM (a prospective, randomized, multicenter trial to assess an everolimus-eluting coronary stent system [PROMUS element] for the treatment of up to two de novo cor). J Am Coll Cardiol 57(16):1700–1708
Windecker S, Simon R, Lins M, Klauss V, Eberli FR, Roffi M, Pedrazzini G, Moccetti T, Wenaweser P, Togni M, Tüller D, Zbinden R, Seiler C, Mehilli J, Kastrati A et al (2005) Randomized comparison of a titanium–nitride–oxide-coated stent with a stainless steel stent for coronary revascularization: the TiNOX trial. Circulation 111(20):2617–2622
Romppanen H, Nammas W, Kervinen K, Airaksinen JKE, Pietilä M, Rivero-Crespo F, Debelder A, Tedjokusumo P, Mikkelsson J, Ylitalo A, Karjalainen PP (2013) Stent-oriented versus patient-oriented outcome in patients undergoing early percutaneous coronary intervention for acute coronary syndrome: 2-year report from the BASE-ACS trial. Ann Med 45(7):488–493
Lehtinen T, Airaksinen KEJ, Ylitalo A, Karjalainen PP (2012) Stent strut coverage of titanium–nitride–oxide coated stent compared to paclitaxel-eluting stent in acute myocardial infarction: TITAX-OCT study. Int J Cardiovasc Imaging 28(8):1859–1866
Annala A-P, Lehtinen T, Kiviniemi TO, Ylitalo A, Nammas W, Karjalainen PP (2013) Vascular healing early after titanium–nitride–oxide-coated stent implantation assessed by optical coherence tomography. J Invasive cardiol 25(4):186–189
Prati F, Romagnoli E, Valgimigli M, Burzotta F, De Benedictis M, Ramondo A, Mehran R, Stella PR (2014) Randomized comparison between 3-month Cre8 DES vs. 1-month Vision/Multilink8 BMS neointimal coverage assessed by OCT evaluation: the DEMONSTRATE study. Int J Cardiol 176(3):904–909
Guagliumi G, Sirbu V, Bezerra H, Biondi-Zoccai G, Fiocca L, Musumeci G, Matiashvili A, Lortkipanidze N, Tahara S, Valsecchi O, Costa M (2010) Strut coverage and vessel wall response to zotarolimus-eluting and bare-metal stents implanted in patients with ST-segment elevation myocardial infarction: the OCTAMI (optical coherence tomography in acute myocardial infarction) study. JACC Cardiovasc Interv 3(6):680–687
Togni M, Räber L, Cocchia R, Wenaweser P, Cook S, Windecker S, Meier B, Hess OM (2007) Local vascular dysfunction after coronary paclitaxel-eluting stent implantation. Int J Cardiol 120(2):212–220
Togni M, Windecker S, Cocchia R, Wenaweser P, Cook S, Billinger M, Meier B, Hess OM (2005) Sirolimus-eluting stents associated with paradoxic coronary vasoconstriction. J Am Coll Cardiol 46(2):231–236
Hofma SH, van der Giessen WJ, van Dalen BM, Lemos PA, McFadden EP, Sianos G, Ligthart JMR, van Essen D, de Feyter PJ, Serruys PW (2006) Indication of long-term endothelial dysfunction after sirolimus-eluting stent implantation. Eur Heart J 27(2):166–170
Ascione L, Carlomagno G, Sordelli C, Iengo R, Monda V, Severino S, Merenda R, D’Andrea A, Caso P (2013) Dipyridamole coronary flow reserve stratifies prognosis in acute coronary syndrome patients without left anterior descending disease. Eur Heart J Cardiovasc Imaging 14(9):858–864
Cortigiani L, Rigo F, Gherardi S, Sicari R, Galderisi M, Bovenzi F, Picano E (2007) Additional prognostic value of coronary flow reserve in diabetic and nondiabetic patients with negative dipyridamole stress echocardiography by wall motion criteria. J Am Coll Cardiol 50(14):1354–1361
Cortigiani L, Rigo F, Gherardi S, Bovenzi F, Molinaro S, Picano E, Sicari R (2012) Coronary flow reserve during dipyridamole stress echocardiography predicts mortality. JACC Cardiovasc Imaging 5(11):1079–1085
Gould KL, Lipscomb K (1974) Effects of coronary stenoses on coronary flow reserve and resistance. Am J Cardiol 34(1):48–55
Acknowledgments
Authors deeply thank RN Minna Ampio, RN Kristiina Lahtonen and RN Tuija Vasankari for their excellent technical assistance. This study was supported by Scholarship for research within the area of Acute Coronary Syndrome from the Finnish Cardiac Society (T.K.); by grants from the Finnish Foundation for Cardiovascular Research, Helsinki, Finland (T.K. and J.A.); and by Turku University Hospital Research Foundation.
Author information
Authors and Affiliations
Corresponding author
Ethics declarations
Conflict of interest
The authors declare that they have no conflicts of interest.
Rights and permissions
About this article
Cite this article
Varho, V., Kiviniemi, T.O., Nammas, W. et al. Early vascular healing after titanium–nitride–oxide-coated stent versus platinum–chromium everolimus-eluting stent implantation in patients with acute coronary syndrome. Int J Cardiovasc Imaging 32, 1031–1039 (2016). https://doi.org/10.1007/s10554-016-0871-7
Received:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s10554-016-0871-7