Optical Coherence Tomography Assessment of In Vivo Vascular Response After Implantation of Overlapping Bare-Metal and Drug-Eluting Stents

被引：141

作者：

Guagliumi, Giulio ^{[1
]}

Musumeci, Giuseppe ^{[1
]}

Sirbu, Vasile ^{[1
]}

Bezerra, Hiram G. ^{[2
]}

Suzuki, Nobuaki ^{[2
]}

Fiocca, Luigi ^{[1
]}

Matiashvili, Aleksandre ^{[1
]}

Lortkipanidze, Nikoloz ^{[1
]}

Trivisonno, Antonio ^{[1
]}

Valsecchi, Orazio ^{[1
]}

Biondi-Zoccai, Giuseppe ^{[3
]}

Costa, Marco A. ^{[2
]}

机构：

[1] Osped Riuniti Bergamo, Div Cardiol, Cardiovasc Dept, I-24121 Bergamo, Italy

[2] Case Western Reserve Univ, Univ Hosp Case Med Ctr, Harrington McLaughlin Heart & Vasc Inst, Cleveland, OH 44106 USA

[3] Univ Turin, Div Cardiol, Turin, Italy

来源：

JACC-CARDIOVASCULAR INTERVENTIONS | 2010年 / 3卷 / 05期

关键词：

coronary artery disease; optical coherence tomography; percutaneous transluminal coronary angioplasty; stent; INTRAVASCULAR ULTRASOUND; THROMBOSIS; COVERAGE;

D O I：

10.1016/j.jcin.2010.02.008

中图分类号：

R5 [内科学];

学科分类号：

1002 ; 100201 ;

摘要：

Objectives We designed a randomized trial exploiting optical coherence tomography (OCT) to assess coverage and apposition of overlapping bare-metal stents (BMS) and drug-eluting stents (DES) in human coronary arteries. Background Overlapping DES impair healing in animals. Optical coherence tomography allows accurate in vivo assessment of stent strut coverage and apposition. Methods Seventy-seven patients with long coronary stenoses were randomized to overlapping sirolimus-eluting stents (SES), paclitaxel-eluting stents (PES), zotarolimus-eluting stents (ZES), or BMS. The primary goal of the study was to determine the rate of uncovered/malapposed strut; in overlap versus nonoverlap segments, according to stent type, at 6-month follow-up with OCT. Results A total of 53,047 struts were analyzed. The rate of uncovered/malapposed struts was 1.5 +/- 3.4% and 0.6 +/- 2.7% in overlap versus nonoverlap BMS (p = NS), respectively, and 4.3 +/- 11% and 3.6 +/- 8% in overlap versus nonoverlap DES (p = NS), respectively. There were no differences in the rates of uncovered/malapposed struts between overlapping BMS and DES, likely due to law frequency of uncovered/malapposed struts in ZES (0.1 +/- 0.4%), which offset the higher rates observed in SES (6.7 +/- 9.6%) and PES (6.7 +/- 16.5%, p < 0.05). Overlap segments showed greater neointimal volume obstruction versus nonoverlap segments in all DES (p < 0.05 for all DES types). Strut-level neointimal thickness at overlap and nonoverlap segments were lowest in SES (0.16 +/- 0.1 mm and 0.12 +/- 0.1 mm, respectively) compared with PES (0.27 +/- 0.1 mm and 0.20 +/- 0.1 mm, respectively), ZES (0.40 +/- 0.16 mm and 0.33 +/- 0.13 mm, respectively), and BMS (0.55 +/- 0.31 mm and 0.53 +/- 0.25 mm, respectively, p < 0.05). Conclusions As assessed by OCT the impact of DES on vascular healing was similar at overlapping and nonoverlapping sites. However, strut malapposition, coverage pattern, and neointimal hyperplasia differ significantly according to DES type. (Optical Coherence Tomography for Drug Eluting Stent Safety [ODESSA]; NCT00693030) (J Am Coll Cardiol Intv 2010;3:531-9) (C) 2010 by the American College of Cardiology Foundation

引用

页码：531 / 539

页数：9

共 15 条

[1] Strut position, blood flow, and drug deposition - Implications for single and overlapping drug-eluting stents [J].

Balakrishnan, B ;

Tzafriri, AR ;

Seifert, P ;

Groothuis, A ;

Rogers, C ;

Edelman, ER .

CIRCULATION, 2005, 111 (22) :2958-2965

[2] Late thrombosis of drug-eluting stents: A meta-analysis of randomized clinical trials [J].

Bavry, Anthony A. ;

Kumbhani, Dharam J. ;

Helton, Thomas J. ;

Borek, Przemyslaw P. ;

Mood, Girish R. ;

Bhatt, Deepak L. .

AMERICAN JOURNAL OF MEDICINE, 2006, 119 (12) :1056-1061

[3] Incomplete stent apposition and very late stent thrombosis after drug-eluting stent implantation [J].

Cook, Stephane ;

Wenaweser, Peter ;

Togni, Mario ;

Billinger, Michael ;

Morger, Cyrill ;

Seiler, Christian ;

Vogel, Rolf ;

Hess, Otto ;

Meier, Bernhard ;

Windecker, Stephan .

CIRCULATION, 2007, 115 (18) :2426-2434

[4] Impact of stent deployment procedural factors on long-term effectiveness and safety of sirolimus-eluting stents (final results of the multicenter prospective STLLR trial) [J].

Costa, Marco A. ;

Angiolillo, Dominick J. ;

Tannenbaum, Mark ;

Driesman, Mitchell ;

Chu, Alan ;

Patterson, John ;

Kuehl, William ;

Battaglia, Joseph ;

Dabbons, Samir ;

Shamoon, Fayez ;

Flieshman, Bruce ;

Niederman, Alan ;

Bass, Theodore A. .

AMERICAN JOURNAL OF CARDIOLOGY, 2008, 101 (12) :1704-1711

[5] Clinical end points in coronary stent trials - A case for standardized definitions [J].

Cutlip, Donald E. ;

Windecker, Stephan ;

Mehran, Roxana ;

Boam, Ashley ;

Cohen, David J. ;

van Es, Gerrit-Anne ;

Steg, P. Gabriel ;

Morel, Marie-angele ;

Mauri, Laura ;

Vranckx, Pascal ;

McFadden, Eugene ;

Lansky, Alexandra ;

Hamon, Martial ;

Krucoff, Mitchell W. ;

Serruys, Patrick W. .

CIRCULATION, 2007, 115 (17) :2344-2351

[6] Vascular responses to drug eluting stents - Importance of delayed healing [J].

Finn, Aloke V. ;

Nakazawa, Gaku ;

Joner, Michael ;

Kolodgie, Frank D. ;

Mont, Erik K. ;

Gold, Herman K. ;

Virmani, Renu .

ARTERIOSCLEROSIS THROMBOSIS AND VASCULAR BIOLOGY, 2007, 27 (07) :1500-1510

[7] Pathological correlates of late drug-eluting stent thrombosis - Strut coverage as a marker of endothelialization [J].

Finn, Aloke V. ;

Joner, Michael ;

Nakazawa, Gaku ;

Kolodgie, Frank ;

Newell, John ;

John, Mike C. ;

Gold, Herman K. ;

Virmani, Renu .

CIRCULATION, 2007, 115 (18) :2435-2441

[8] Differential response of delayed healing and persistent inflammation at sites of overlapping sirolimus- or paclitaxel-eluting stents [J].

Finn, AV ;

Kolodgie, FD ;

Harnek, J ;

Guerrero, LJ ;

Acampado, E ;

Tefera, K ;

Skorija, K ;

Weber, DK ;

Gold, HK ;

Virmani, R .

CIRCULATION, 2005, 112 (02) :270-278

[9] Optical coherence tomography: High resolution intravascular imaging to evaluate vascular healing after coronary stenting [J].

Guagliumi, Giulio ;

Sirbu, Vasile .

CATHETERIZATION AND CARDIOVASCULAR INTERVENTIONS, 2008, 72 (02) :237-247

[10] Pathology of drug-eluting stents in humans - Delayed healing and late thrombotic risk [J].

Joner, Michael ;

Finn, Aloke V. ;

Farb, Andrew ;

Mont, Erik K. ;

Kolodgie, Frank D. ;

Ladich, Elena ;

Kutys, Robert ;

Skorija, Kristi ;

Gold, Herman K. ;

Virmani, Renu .

JOURNAL OF THE AMERICAN COLLEGE OF CARDIOLOGY, 2006, 48 (01) :193-202

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