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Coronary Angioscopic Insights into Several Drug-Eluting Stents of Different Platforms

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Abstract

Several drug-eluting stents (DESs) of different platforms have been approved in the world, and comparisons of clinical outcomes with these DESs have raised much interest among coronary interventionists. Next-generation DESs have dramatically reduced the incidences of clinical events, especially late and very late stent thrombosis, which made it difficult to assess the safety thereof in a clinical study. On the other hand, coronary angioscopy allows the qualitative or semiquantitative assessment of arterial healing after DES implantation in patients with coronary artery disease.

In Japan, many investigators have already accumulated much coronary angioscopic evidence. Furthermore, those angioscopic studies have provided a great deal of information useful for the safe and effective use of DESs.

In this chapter, we present differences in angioscopic findings among several DESs of different platforms. Based on these findings, in addition, we also refer to technological innovations that are required for the future development of next-generation DESs.

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References

  1. Awata M, Kotani J, Nanto S, Uematsu M, Morozumi T, Hori M, Nagata S. Sustained attenuation of neointimal coverage over the stent following brachytherapy for in-stent restenosis: angioscopic findings. Circ J. 2006;70(7):846–50.

    Article  PubMed  Google Scholar 

  2. Kotani J, Awata M, Nanto S, Uematsu M, Oshima F, Minamiguchi H, Mintz GS, Nagata S. Incomplete neointimal coverage of sirolimus-eluting stents: angioscopic findings. J Am Coll Cardiol. 2006;47(10):2108–11. doi:10.1016/j.jacc.2005.11.092.

    Article  CAS  PubMed  Google Scholar 

  3. Awata M, Kotani J, Uematsu M, Morozumi T, Watanabe T, Onishi T, Iida O, Sera F, Nanto S, Hori M, Nagata S. Serial angioscopic evidence of incomplete neointimal coverage after sirolimus-eluting stent implantation: comparison with bare-metal stents. Circulation. 2007;116(8):910–16. doi:10.1161/CIRCULATIONAHA.105.609057.

    Article  CAS  PubMed  Google Scholar 

  4. Awata M, Nanto S, Uematsu M, Morozumi T, Watanabe T, Onishi T, Iida O, Sera F, Kotani J, Hori M, Nagata S. Angioscopic comparison of neointimal coverage between zotarolimus- and sirolimus-eluting stents. J Am Coll Cardiol. 2008;52(9):789–90. doi:10.1016/j.jacc.2008.07.007.

    Article  CAS  PubMed  Google Scholar 

  5. Awata M, Nanto S, Uematsu M, Morozumi T, Watanabe T, Onishi T, Iida O, Sera F, Minamiguchi H, Kotani J, Nagata S. Heterogeneous arterial healing in patients following paclitaxel-eluting stent implantation: comparison with sirolimus-eluting stents. J Am Coll Cardiol Intv. 2009;2(5):453–8. doi:10.1016/j.jcin.2009.03.005.

    Article  Google Scholar 

  6. Takano M, Yamamoto M, Murakami D, Inami S, Okamatsu K, Seimiya K, Ohba T, Seino Y, Mizuno K. Lack of association between large angiographic late loss and low risk of in-stent thrombus: angioscopic comparison between paclitaxel- and sirolimus-eluting stents. Circ Cardiovasc Interv. 2008;1(1):20–7. doi:10.1161/CIRCINTERVENTIONS.108.769448.

    Article  PubMed  Google Scholar 

  7. Awata M, Uematsu M, Sera F, Ishihara T, Watanabe T, Fujita M, Onishi T, Iida O, Ishida Y, Nanto S, Nagata S. Angioscopic assessment of arterial repair following biodegradable polymer-coated biolimus A9-eluting stent implantation. Circ J. 2011;75(5):1113–19. doi:10.1253/circj.CJ-10-0776.

    Article  PubMed  Google Scholar 

  8. Ishihara T, Awata M, Sera F, Fujita M, Watanabe T, Iida O, Ishida Y, Nanto S, Uematsu M. Arterial repair 4 months after zotarolimus-eluting stent implantation observed on angioscopy. Circ J. 2013;77(5):1186–92. doi:10.1253/circj.CJ-12-1369.

    Article  PubMed  Google Scholar 

  9. Mitsutake Y, Ueno T, Yokoyama S, Sasaki K, Sugi Y, Toyama Y, Koiwaya H, Ohtsuka M, Nakayoshi T, Itaya N, Chibana H, Kakuma T, Imaizumi T. Coronary endothelial dysfunction distal to stent of first-generation drug-eluting stents. J Am Coll Cardiol Intv. 2012;5(9):966–73. doi:10.1016/j.jcin.2012.06.010.

    Article  Google Scholar 

  10. Finn AV, Joner M, Nakazawa G, Kolodgie F, Newell J, John MC, Gold HK, Virmani R. Pathological correlates of late drug-eluting stent thrombosis: strut coverage as a marker of endothelialization. Circulation. 2007;115(18):2435–41. doi:10.1161/CIRCULATIONAHA.107.693739.

    Article  PubMed  Google Scholar 

  11. Ishihara T, Awata M, Fujita M, Watanabe T, Iida O, Ishida Y, Nanto S, Uematsu M. Angioscopic assessment of peri-stent contrast staining following drug-eluting stent implantation. Circ J. 2014;78(1):122–7. doi:10.1253/circj.CJ-13-0464.

    Article  PubMed  Google Scholar 

  12. Takano M, Yamamoto M, Xie Y, Murakami D, Inami S, Okamatsu K, Seimiya K, Ohba T, Seino Y, Mizuno K. Serial long-term evaluation of neointimal stent coverage and thrombus after sirolimus-eluting stent implantation by use of coronary angioscopy. Heart. 2007;93(12):1533–6. doi:10.1136/hrt.2007.131714.

    Article  PubMed Central  PubMed  Google Scholar 

  13. Asakura M, Ueda Y, Nanto S, Hirayama A, Adachi T, Kitakaze M, Hori M, Kodama K. Remodeling of in-stent neointima, which became thinner and transparent over 3 years: serial angiographic and angioscopic follow-up. Circulation. 1998;97(20):2003–6.

    Article  CAS  PubMed  Google Scholar 

  14. Oyabu J, Ueda Y, Ogasawara N, Okada K, Hirayama A, Kodama K. Angioscopic evaluation of neointima coverage: sirolimus drug-eluting stent versus bare metal stent. Am Heart J. 2006;152(6):1168–74. doi:10.1016/j.ahj.2006.07.025.

    Article  CAS  PubMed  Google Scholar 

  15. Ueda Y, Ohtani T, Shimizu M, Hirayama A, Kodama K. Assessment of plaque vulnerability by angioscopic classification of plaque color. Am Heart J. 2004;148(2):333–5. doi:10.1016/j.ahj.2004.03.047.

    Article  PubMed  Google Scholar 

  16. Joner M, Finn AV, Farb A, Mont EK, Kolodgie FD, Ladich E, Kutys R, Skorija K, Gold HK, Virmani R. Pathology of drug-eluting stents in humans: delayed healing and late thrombotic risk. J Am Coll Cardiol. 2006;48(1):193–202. doi:10.1016/j.jacc.2006.03.042.

    Article  PubMed  Google Scholar 

  17. Virmani R, Guagliumi G, Farb A, Musumeci G, Grieco N, Motta T, Mihalcsik L, Tespili M, Valsecchi O, Kolodgie FD. Localized hypersensitivity and late coronary thrombosis secondary to a sirolimus-eluting stent: should we be cautious? Circulation. 2004;109(6):701–5. doi:10.1161/01.CIR.0000116202.41966.D4.

    Article  PubMed  Google Scholar 

  18. Nakazawa G, Otsuka F, Nakano M, Vorpahl M, Yazdani SK, Ladich E, Kolodgie FD, Finn AV, Virmani R. The pathology of neoatherosclerosis in human coronary implants bare-metal and drug-eluting stents. J Am Coll Cardiol. 2011;57(11):1314–22. doi:10.1016/j.jacc.2011.01.011.

    Article  CAS  PubMed Central  PubMed  Google Scholar 

  19. Higo T, Ueda Y, Oyabu J, Okada K, Nishio M, Hirata A, Kashiwase K, Ogasawara N, Hirotani S, Kodama K. Atherosclerotic and thrombogenic neointima formed over sirolimus drug-eluting stent: an angioscopic study. J Am Coll Cardiol Img. 2009;2(5):616–24. doi:10.1016/j.jcmg.2008.12.026.

    Article  Google Scholar 

  20. Takano M, Jang IK, Inami S, Yamamoto M, Murakami D, Okamatsu K, Seimiya K, Ohba T, Mizuno K. In vivo comparison of optical coherence tomography and angioscopy for the evaluation of coronary plaque characteristics. Am J Cardiol. 2008;101(4):471–6. doi:10.1016/j.amjcard.2007.09.106.

    Article  PubMed  Google Scholar 

  21. Sakai S, Mizuno K, Yokoyama S, Tanabe J, Shinada T, Seimiya K, Takano M, Ohba T, Tomimura M, Uemura R, Imaizumi T. Morphologic changes in infarct-related plaque after coronary stent placement: a serial angioscopy study. J Am Coll Cardiol. 2003;42(9):1558–65.

    Article  PubMed  Google Scholar 

  22. Cutlip DE, Chhabra AG, Baim DS, Chauhan MS, Marulkar S, Massaro J, Bakhai A, Cohen DJ, Kuntz RE, Ho KK. Beyond restenosis: five-year clinical outcomes from second-generation coronary stent trials. Circulation. 2004;110(10):1226–30. doi:10.1161/01.CIR.0000140721.27004.4B.

    Article  PubMed  Google Scholar 

  23. Kimura T, Morimoto T, Nakagawa Y, Kawai K, Miyazaki S, Muramatsu T, Shiode N, Namura M, Sone T, Oshima S, Nishikawa H, Hiasa Y, Hayashi Y, Nobuyoshi M, Mitudo K, j-Cypher Registry I. Very late stent thrombosis and late target lesion revascularization after sirolimus-eluting stent implantation: five-year outcome of the j-Cypher Registry. Circulation. 2012;125(4):584–91. doi:10.1161/CIRCULATIONAHA.111.046599.

    Article  CAS  PubMed  Google Scholar 

  24. Yamamoto M, Takano M, Murakami D, Inami T, Kobayashi N, Inami S, Okamatsu K, Ohba T, Ibuki C, Hata N, Seino Y, Jang IK, Mizuno K. The possibility of delayed arterial healing 5 years after implantation of sirolimus-eluting stents: serial observations by coronary angioscopy. Am Heart J. 2011;161(6):1200–6. doi:10.1016/j.ahj.2011.03.006.

    Article  CAS  PubMed  Google Scholar 

  25. Nishino M, Yoshimura T, Nakamura D, Lee Y, Taniike M, Makino N, Kato H, Egami Y, Shutta R, Tanouchi J, Yamada Y. Comparison of angioscopic findings and three-year cardiac events between sirolimus-eluting stent and bare-metal stent in acute myocardial infarction. Am J Cardiol. 2011;108(9):1238–43. doi:10.1016/j.amjcard.2011.06.038.

    Article  CAS  PubMed  Google Scholar 

  26. Ishihara T, Awata M, Fujita M, Watanabe T, Iida O, Ishida Y, Nanto S, Uematsu M. Very late stent thrombosis 5 years after implantation of a sirolimus-eluting stent observed by angioscopy and optical coherence tomography. J Am Coll Cardiol Intv. 2013;6(5):e28–30. doi:10.1016/j.jcin.2012.12.127.

    Article  Google Scholar 

  27. Hara M, Nishino M, Taniike M, Makino N, Kato H, Egami Y, Shutta R, Yamaguchi H, Tanouchi J, Yamada Y. High incidence of thrombus formation at 18 months after paclitaxel-eluting stent implantation: angioscopic comparison with sirolimus-eluting stent. Am Heart J. 2010;159(5):905–10. doi:10.1016/j.ahj.2010.02.032.

    Article  CAS  PubMed  Google Scholar 

  28. Hara M, Nishino M, Taniike M, Makino N, Kato H, Egami Y, Shutta R, Tanouchi J, Yamada Y. Serial angioscopic evaluation of neointimal coverage and incidence of thrombus formation after Paclitaxel-eluting stent implantation: comparison between 6- and 18-month follow-up. Clin Cardiol. 2011;34(5):322–6. doi:10.1002/clc.20881.

    Article  PubMed  Google Scholar 

  29. Mauri L, Orav EJ, Candia SC, Cutlip DE, Kuntz RE. Robustness of late lumen loss in discriminating drug-eluting stents across variable observational and randomized trials. Circulation. 2005;112(18):2833–9. doi:10.1161/CIRCULATIONAHA105.570093.

    Article  PubMed  Google Scholar 

  30. Maeng M, Tilsted HH, Jensen LO, Kaltoft A, Kelbaek H, Abildgaard U, Villadsen AB, Krusell LR, Ravkilde J, Hansen KN, Christiansen EH, Aaroe J, Jensen JS, Kristensen SD, Botker HE, Madsen M, Thayssen P, Sorensen HT, Thuesen L, Lassen JF. 3-Year clinical outcomes in the randomized SORT OUT III superiority trial comparing zotarolimus- and sirolimus-eluting coronary stents. J Am Coll Cardiol Intv. 2012;5(8):812–18. doi:10.1016/j.jcin.2012.04.008.

    Article  Google Scholar 

  31. Hamilos M, Sarma J, Ostojic M, Cuisset T, Sarno G, Melikian N, Ntalianis A, Muller O, Barbato E, Beleslin B, Sagic D, De Bruyne B, Bartunek J, Wijns W. Interference of drug-eluting stents with endothelium-dependent coronary vasomotion: evidence for device-specific responses. Circ Cardiovasc Interv. 2008;1(3):193–200. doi:10.1161/CIRCINTERVENTIONS.108.797928.

    Article  PubMed  Google Scholar 

  32. Joner M, Nakazawa G, Finn AV, Quee SC, Coleman L, Acampado E, Wilson PS, Skorija K, Cheng Q, Xu X, Gold HK, Kolodgie FD, Virmani R. Endothelial cell recovery between comparator polymer-based drug-eluting stents. J Am Coll Cardiol. 2008;52(5):333–42. doi:10.1016/j.jacc.2008.04.030.

    Article  CAS  PubMed  Google Scholar 

  33. Kim BK, Hong MK, Shin DH, Nam CM, Kim JS, Ko YG, Choi D, Kang TS, Park BE, Kang WC, Lee SH, Yoon JH, Hong BK, Kwon HM, Jang Y, Investigators R. A new strategy for discontinuation of dual antiplatelet therapy: the RESET Trial (REal Safety and Efficacy of 3-month dual antiplatelet Therapy following Endeavor zotarolimus-eluting stent implantation). J Am Coll Cardiol. 2012;60(15):1340–8. doi:10.1016/j.jacc.2012.06.043.

    Article  CAS  PubMed  Google Scholar 

  34. Feres F, Costa RA, Abizaid A, Leon MB, Marin-Neto JA, Botelho RV, King 3rd SB, Negoita M, Liu M, de Paula JE, Mangione JA, Meireles GX, Castello Jr HJ, Nicolela Jr EL, Perin MA, Devito FS, Labrunie A, Salvadori Jr D, Gusmao M, Staico R, Costa Jr JR, de Castro JP, Abizaid AS, Bhatt DL, Investigators OT. Three vs twelve months of dual antiplatelet therapy after zotarolimus-eluting stents: the OPTIMIZE randomized trial. J Am Med Assoc. 2013;310(23):2510–22. doi:10.1001/jama.2013.282183.

    CAS  Google Scholar 

  35. Akazawa Y, Matsuo K, Ueda Y, Nishio M, Hirata A, Asai M, Nemoto T, Wada M, Murakami A, Kashiwase K, Kodama K. Atherosclerotic change at one year after implantation of endeavor zotarolimus-eluting stent vs. everolimus-eluting stent. Circ J. 2014;78(6):1428–36. doi:10.1253/circj.CJ-14-0085.

    Article  PubMed  Google Scholar 

  36. Kandzari DE, Leon MB, Meredith I, Fajadet J, Wijns W, Mauri L. Final 5-year outcomes from the Endeavor zotarolimus-eluting stent clinical trial program: comparison of safety and efficacy with first-generation drug-eluting and bare-metal stents. J Am Coll Cardiol Intv. 2013;6(5):504–12. doi:10.1016/j.jcin.2012.12.125.

    Article  Google Scholar 

  37. Dai K, Ishihara M, Inoue I, Kawagoe T, Shimatani Y, Miura F, Nakama Y, Otani T, Ooi K, Ikenaga H, Nakamura M, Miki T, Kishimoto S, Sumimoto Y. Coronary angioscopic findings 9 months after everolimus-eluting stent implantation compared with sirolimus-eluting stents. J Cardiol. 2013;61(1):22–30. doi:10.1016/j.jjcc.2012.08.011.

    Article  PubMed  Google Scholar 

  38. Sawada T, Shinke T, Otake H, Mizoguchi T, Iwasaki M, Emoto T, Terashita D, Mizuguchi T, Okamoto H, Matsuo Y, Kim SK, Takarada A, Yokoyama M. Comparisons of detailed arterial healing response at seven months following implantation of an everolimus- or sirolimus-eluting stent in patients with ST-segment elevation myocardial infarction. Int J Cardiol. 2013;168(2):960–6. doi:10.1016/j.ijcard.2012.10.043.

    Article  PubMed  Google Scholar 

  39. Kolandaivelu K, Swaminathan R, Gibson WJ, Kolachalama VB, Nguyen-Ehrenreich KL, Giddings VL, Coleman L, Wong GK, Edelman ER. Stent thrombogenicity early in high-risk interventional settings is driven by stent design and deployment and protected by polymer-drug coatings. Circulation. 2011;123(13):1400–9. doi:10.1161/CIRCULATIONAHA.110.003210.

    Article  CAS  PubMed Central  PubMed  Google Scholar 

  40. Sera F, Awata M, Uematsu M, Kotani J, Nanto S, Nagata S. Optimal stent-sizing with intravascular ultrasound contributes to complete neointimal coverage after sirolimus-eluting stent implantation assessed by angioscopy. J Am Coll Cardiol Intv. 2009;2(10):989–94. doi:10.1016/j.jcin.2009.07.006.

    Article  Google Scholar 

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Correspondence to Masaki Awata M.D., Ph.D. .

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Awata, M., Uematsu, M. (2015). Coronary Angioscopic Insights into Several Drug-Eluting Stents of Different Platforms. In: Mizuno, K., Takano, M. (eds) Coronary Angioscopy. Springer, Tokyo. https://doi.org/10.1007/978-4-431-55546-9_15

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  • DOI: https://doi.org/10.1007/978-4-431-55546-9_15

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