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


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.


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



Drug-elluting stents


In-stent restenosis


Target vessel revascularization


Bare metal stent


Very late stent thrombosis


Late stent thrombosis


Stent thrombosis


Optical coherence tomography


Quantitative coronary angiography


Intravascular ultrasound




Reference vessel diameter


Minimal lesion diameter


Lumen loss


Vessel volume


Stent volume


Lumen volume


In-stent neointimal hyperplasia


In-stent neointimal hyperplasia index


Stent extension


Stent obstruction


Diameter stent


Sirolimus-eluting stent


Paclitaxel-eluting stent


Confidential interval


Non significant


Standard deviation




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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