Very long-term follow-up of strut apposition and tissue coverage with Biolimus A9 stents analyzed by optical coherence tomography

  • Rodolfo Staico
  • Marco A. Costa
  • Daniel Chamié
  • Hiram Bezerra
  • Luciana V. Armaganijan
  • Ricardo A. Costa
  • José Ribamar Costa
  • Dimytri Siqueira
  • Marinella Centemero
  • Áurea Chaves
  • Luiz Fernando Tanajura
  • Alexandre Abizaid
  • Fausto Feres
  • J. Eduardo M. R. Sousa
  • Amanda G. M. R. Sousa
Original Paper

Abstract

First generation drug-eluting stents (DES) are associated with reduced in-stent restenosis but significant increased risk of very late stent thrombosis (VLST). The absence of polymer in DES systems may reduce the occurrence of VLST. Optic coherence tomography (OCT) has been used for stent analysis as a surrogate safety endpoint. This study aimed to assess the long-term follow up of strut apposition and tissue coverage of BioMatrix™ DES by OCT. 20 patients undergoing BioMatrix™ DES (n = 15) or S-Stent™ BMS (n = 5) implantation were followed for at least 5 years and evaluated by quantitative coronary angiography, intravascular ultrasound, and OCT. The difference between the stent types was evaluated by nonparametric Mann–Whitney U test while categorical variables were evaluated by Fisher exact test. Rates of in-stent late loss were similar between groups [0.40 (0.21;0.77) vs. 0.68 (0.66; 0.82) mm, p = 0.205, for BioMatrix™ and S-Stent™, respectively]. The vessel, stent and lumen volumes did not differ between groups. Patients treated with BioMatrix™ had significantly less stent obstruction [5.6 (4.4;9.7) vs. 28.6 (24.7;29.0) %, p = 0.001]. OCT analysis of 12 stents (Biomatrix™ = 9 and S-Stent™ = 3) demonstrated 126 (8.7 %) uncovered struts in the BioMatrix™ group compared to 23 (4.0 %) in the S-Stent™ group (p = 0.297), being the majority of them well apposed (117/126 and 21/23, respectively, p = 0.292). Only 9 (0.6 %) struts in the DES and 2 (0.4 %) struts in the BMS groups were simultaneously uncovered and malapposed (p = 0.924). BioMatrix™ DES was associated with lower rates of in-stent obstruction, and similar percentage of neointimal coverage on struts and of complete strut apposition.

Keywords

Coronary artery disease Drug-eluting stents Biolimus A9 Optical coherence tomography Interventional ultrasound Coronary angiography 

Abbreviations

DES

Drug-elluting stents

ISR

In-stent restenosis

TVR

Target vessel revascularization

BMS

Bare metal stent

VLST

Very late stent thrombosis

LST

Late stent thrombosis

ST

Stent thrombosis

OCT

Optical coherence tomography

QCA

Quantitative coronary angiography

IVUS

Intravascular ultrasound

EKG

Electrocardiogram

RVD

Reference vessel diameter

MLD

Minimal lesion diameter

LL

Lumen loss

VV

Vessel volume

ST

Stent volume

LV

Lumen volume

NIH

In-stent neointimal hyperplasia

NIH

In-stent neointimal hyperplasia index

SE

Stent extension

SO

Stent obstruction

DS

Diameter stent

SES

Sirolimus-eluting stent

PES

Paclitaxel-eluting stent

CI

Confidential interval

NS

Non significant

SD

Standard deviation

IQ

Interquartile

PCI

Percutaneous coronary intervention

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Copyright information

© Springer Science+Business Media Dordrecht 2013

Authors and Affiliations

  • Rodolfo Staico
    • 1
  • Marco A. Costa
    • 2
  • Daniel Chamié
    • 2
  • Hiram Bezerra
    • 2
  • Luciana V. Armaganijan
    • 1
  • Ricardo A. Costa
    • 1
  • José Ribamar Costa
    • 1
  • Dimytri Siqueira
    • 1
  • Marinella Centemero
    • 1
  • Áurea Chaves
    • 1
  • Luiz Fernando Tanajura
    • 1
  • Alexandre Abizaid
    • 1
  • Fausto Feres
    • 1
  • J. Eduardo M. R. Sousa
    • 1
  • Amanda G. M. R. Sousa
    • 1
  1. 1.Dante Pazzanese Institute of CardiologyVila Mariana, São PauloBrazil
  2. 2.Case Western Reserve UniversityClevelandUSA

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