Comparison of neointimal hyperplasia and peri-stent vascular remodeling after implantation of everolimus-eluting versus sirolimus-eluting stents: intravascular ultrasound results from the EXCELLENT study

  • Young-Guk Ko
  • Dong-Ho Shin
  • Jung-Sun Kim
  • Byeong-Keuk Kim
  • Donghoon Choi
  • Myeong-Ki Hong
  • Hyeon-Cheol Gwon
  • Taehoon Ahn
  • In-Ho Chae
  • Jung-Han Yoon
  • Hyo-Soo Kim
  • Yangsoo Jang
  • EXCELLENT investigators
Original Paper


This study was designed to compare neointimal hyperplasia and peri-stent arterial remodeling after implantation of everolimus-eluting stent (EES) versus sirolimus-eluting stent (SES) using intravascular ultrasound (IVUS). The study population was a subgroup of 278 patients from the EXCELLENT trial, a randomized study comparing EES to SES in de novo coronary artery lesions (total n = 1,443, 3:1 randomization) who underwent post-PCI and 9-month follow-up IVUS evaluation. There were 209 patients in the EES group and 69 in the SES group. Baseline clinical and angiographic characteristics were similar between the two groups except for age and target lesion locations. At 9 months, percent neointimal volume obstruction did not differ between EES and SES (2.6 ± 4.0 % vs. 2.5 ± 4.8 %, p = 0.814). However, the relative change in the vessel (4.3 ± 13.7 % vs. 8.8 ± 18.6 %, p = 0.030) and plaque volume index (4.2 ± 17.4 % vs. 10.5 ± 22.3 %, p = 0.016) of the stented segment from post-intervention to follow-up was significantly less with EES than with SES. In addition, positive peri-stent vascular remodeling defined as an increase in vessel volume index >10 % (27.8 vs. 42.0 %, p = 0.027) and late acquired stent malapposition (LASM, 1.9 vs. 15.9 %, p < 0.001) were observed less frequently with EES than SES. EES and SES were similarly effective in reducing neointimal hyperplasia. However, positive peri-stent vascular remodeling and LASM occurred less frequently with EES than SES.


Drug-eluting stent Intravascular ultrasound Neointimal hyperplasia Vascular remodeling 



This study was partly supported by a grant from the Korea Healthcare Technology R&D Project, Ministry for Health, Welfare & Family Affairs, Republic of Korea (No. A085012, A102064, and A110879); a grant from the Korea Health 21 R&D Project, Ministry of Health & Welfare, Republic of Korea (No. A085136); and the Cardiovascular Research Center, Seoul, Korea.

Conflict of interest

The authors also received research grants from Abbott Vascular Korea and Boston Scientific Korea. The funding sources of the study had no role in study design, data collection, monitoring, analysis, interpretation, or writing of the manuscript.


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Copyright information

© Springer Science+Business Media Dordrecht 2013

Authors and Affiliations

  • Young-Guk Ko
    • 1
  • Dong-Ho Shin
    • 1
  • Jung-Sun Kim
    • 1
  • Byeong-Keuk Kim
    • 1
  • Donghoon Choi
    • 1
  • Myeong-Ki Hong
    • 1
  • Hyeon-Cheol Gwon
    • 2
  • Taehoon Ahn
    • 3
  • In-Ho Chae
    • 4
  • Jung-Han Yoon
    • 5
  • Hyo-Soo Kim
    • 6
  • Yangsoo Jang
    • 1
    • 7
  • EXCELLENT investigators
  1. 1.Division of Cardiology, Severance Cardiovascular HospitalYonsei University Health SystemSeodaemun-gu, SeoulKorea
  2. 2.Samsung Medical CenterSung-Kyun-Kwan UniversitySeoulKorea
  3. 3.Gil Medical CenterGachon UniversityIncheonKorea
  4. 4.Seoul National University Bundang HospitalSungnamKorea
  5. 5.Wonju Severance HospitalYonsei UniversityWonjuKorea
  6. 6.Seoul National University Main HospitalSeoulKorea
  7. 7.Severance Biomedical Science InstituteYonsei University Health SystemSeodaemun-gu, SeoulKorea

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