Delayed Coverage in Malapposed and Side-Branch Struts With Respect to Well-Apposed Struts in Drug-Eluting Stents In Vivo Assessment With Optical Coherence Tomography

被引:108
作者
Gutierrez-Chico, Juan Luis [1 ]
Regar, Evelyn [1 ]
Nueesch, Eveline [2 ,3 ]
Okamura, Takayuki [1 ]
Wykrzykowska, Joanna [1 ]
di Mario, Carlo [4 ]
Windecker, Stephan [5 ]
van Es, Gerrit-Anne [6 ]
Gobbens, Pierre [6 ]
Jueni, Peter [2 ,3 ]
Serruys, Patrick W. [1 ]
机构
[1] Erasmus MC, Thoraxctr, NL-3015 CE Rotterdam, Netherlands
[2] Univ Bern, Inst Social & Prevent Med, Bern, Switzerland
[3] Univ Hosp Bern, CTU Bern, CH-3010 Bern, Switzerland
[4] Royal Brompton Hosp, London SW3 6LY, England
[5] Univ Bern, Inselspital, Schweizer Herzzentrum, CH-3010 Bern, Switzerland
[6] Cardialysis BV, Rotterdam, Netherlands
关键词
drug eluting stent; malapposition; neointima; optical coherence tomography; INTRAVASCULAR ULTRASOUND FINDINGS; VESSEL WALL RESPONSE; BARE-METAL STENTS; MYOCARDIAL-INFARCTION; BIFURCATION LESIONS; DURABLE POLYMER; THROMBOSIS; IMPLANTATION; PACLITAXEL; APPOSITION;
D O I
10.1161/CIRCULATIONAHA.110.014514
中图分类号
R5 [内科学];
学科分类号
1002 ; 100201 ;
摘要
Background-Pathology studies on fatal cases of very late stent thrombosis have described incomplete neointimal coverage as common substrate, in some cases appearing at side-branch struts. Intravascular ultrasound studies have described the association between incomplete stent apposition (ISA) and stent thrombosis, but the mechanism explaining this association remains unclear. Whether the neointimal coverage of nonapposed side-branch and ISA struts is delayed with respect to well-apposed struts is unknown. Methods and Results-Optical coherence tomography studies from 178 stents implanted in 99 patients from 2 randomized trials were analyzed at 9 to 13 months of follow-up. The sample included 38 sirolimus-eluting, 33 biolimus-eluting, 57 everolimus-eluting, and 50 zotarolimus-eluting stents. Optical coherence tomography coverage of nonapposed side-branch and ISA struts was compared with well-apposed struts of the same stent by statistical pooled analysis with a random-effects model. A total of 34 120 struts were analyzed. The risk ratio of delayed coverage was 9.00 (95% confidence interval, 6.58 to 12.32) for nonapposed side-branch versus well-apposed struts, 9.10 (95% confidence interval, 7.34 to 11.28) for ISA versus well-apposed struts, and 1.73 (95% confidence interval, 1.34 to 2.23) for ISA versus nonapposed side-branch struts. Heterogeneity of the effect was observed in the comparison of ISA versus well-apposed struts (H=1.27; I-2=38.40) but not in the other comparisons. Conclusions-Coverage of ISA and nonapposed side-branch struts is delayed with respect to well-apposed struts in drug-eluting stents, as assessed by optical coherence tomography.
引用
收藏
页码:612 / U192
页数:21
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