Neointimal Coverage of Bare Metal and Sirolimus-Eluting Stents Evaluated with Optical Coherence Tomography

Bu Xing Chen ^1*, Feng Yun Ma ¹, Lou Wei ¹, Jiang Hong Ruan ¹, Wen Li Xie ¹, Xi Zhe Zhao ¹, Shu Hong Sun ¹, Xu Mei Guo ¹, Feng Wang ¹, Ting Tian ¹ and Xiao Wen Chu ¹

¹ Beijing Electric Power Hospital, China

^* To whom correspondence should be addressed. E-mail: chbux{at}sohu.com.

Accepted 21 August 2007

Abstract

Objective To analyze the neointimal coverage of Sirolimus-Eluting Stent (SES) and bare metal stent (BMS) visualized in vivo by Optical Coherence Tomography (OCT).

Methods OCT images were obtained in 26 coronary vessels in 24 patients at 5-93 months post SES or BMS deployment. The short-term BMS group (BMS1) consisted of 8 BMS in 7 patients at 5-10 months follow-up, the long-term BMS group (BMS2) consisted of 6 BMS in 6 patients at 23-93 months follow-up, and the SES group (SES) consisted of 13 SES in 10 patients at 6-12 months follow-up. The strut apposition, strut coverage, and mean maximal and minimal neointimal thicknesses (NIT) for both BMS groups and SES were compared.

Results OCT images were acquired successfully. Significant differences between completely apposed and malapposed stent struts (p < 0.0001) and between covered and uncovered stent struts (p < 0.0001) were found among the three groups. The mean maximal, and minimal NIT in the SES group were all significantly less than that of the BMS1 or BMS2 group, the minimal NIT in the BMS1 group was significantly less than that of the BMS2, but mean maximal NIT was no significant difference between the BMS1 and BMS2 group. In an open bifurcation artery, 19 struts visualized by OCT had no discernible coverage or were surrounded by either thrombus or a thick tissue layer.

Conclusions OCT imaging can clearly visualize stent apposition and neointimal coverage of stent struts. Incomplete strut apposition and lack of strut coverage occurred with a significantly higher frequency in SES than in BMS. These findings may explain the occurrence of late thrombosis in SES.

Keywords: Neointima, Optical Coherence Tomography, Sirolimus, Stent, Thrombus

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