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Angiographic, IVUS and OCT evaluation of the long-term impact of coronary disease severity at the site of overlapping drug-eluting and bare metal stents: a substudy of the ODESSA trial
  1. Satoko Tahara1,
  2. Hiram G Bezerra1,
  3. Vasile Sirbu2,
  4. Hiroyuki Kyono1,
  5. Giuseppe Musumeci2,
  6. Noah Rosenthal1,
  7. Giulio Guagliumi2,
  8. Marco A Costa1
  1. 1Harrington McLaughlin Heart and Vascular Institute, University Hospitals Case Medical Centre and Case Western Reserve University, Cleveland, Ohio, USA
  2. 2Azienda Ospedaliera Ospedali Riuniti di Bergamo, Bergamo, Italy
  1. Correspondence to Dr Marco A Costa, Harrington McLaughlin Heart and Vascular Institute, University Hospitals Case Medical Centre, 11100 Euclid Avenue, Cleveland, OH 44106-5038, USA; marco.costa{at}uhhospitals.org

Abstract

Background A potentially adverse vascular response to overlapping drug eluting stents (DES) has been suggested in current research.

Objective To evaluate the impact of baseline disease severity at the site of stent overlap.

Methods and results This is a substudy of ODESSA, a prospective, randomised controlled trial designed to evaluate healing of overlapping stents. 71/77 patients with a total of 86 overlapping stents were studied: 25 sirolimus, 24 paclitaxel, 26 zotarolimus-eluting stents; and 11 bare metal stents (BMS). Patients were categorised into high-grade stenosis (HGS, ≥70% diameter stenosis) and low-grade stenosis (LGS, <70%) at the site of stent overlap. Angiography and intravascular ultrasound were performed after stent deployment and repeated at 6 months, together with additional optical coherence tomography. Images were analysed by an independent core laboratory. End points were binary restenosis, percentage neointimal hyperplasia (%NIH), mean lumen and stent areas and degree of strut coverage/apposition at overlapping stents at 6 months. Stent overlaps occurred in 49 HGS and 37 LGS. Restenosis was found in 5/6 HGS versus 0/5 LGS treated with overlapping BMS (p=0.01) and 4/43 HGS versus 0/32 LGS treated with overlapping DES. There was a trend towards higher %NIH at BMS overlap in HGS versus LGS (p=0.07). DES overlaps had lower lumen and stent areas and similar %NIH in HGS versus LGS. Any uncovered or malapposed struts occurred more often in overlapping DES at LGS than at HGS (59.4% vs 32.6%, p=0.03).

Conclusions Overlapping DES in normal-appearing coronary segments showed a higher incidence of uncovered or malapposed struts, while restenosis occurred exclusively in overlapping stents at HGS. These findings should be considered when deploying overlapping stents.

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Footnotes

  • Funding Supported by Ospedali Riuniti Bergamo, Bergamo, Italy, University Hospitals of Cleveland and Case Western Reserve University, Cleveland, USA, with grant support from Medtronic Vascular, Santa Clara, USA, Boston Scientific Corporation, Natick, USA.

  • Competing interests MAC reports receiving consulting fees from Lightlab, Medtronic, Scitech, Cordis, Boston Scientifics and Abbott Vascular. GG reports receiving consulting fees from Boston Scientific and Volcano and receiving grant support from LightLab, Medtronic Vascular, Boston Scientific and Abbott Vascular.

  • Patient consent Obtained.

  • Ethics approval This study was conducted with the approval of the Ospedali Riuniti di Bergamo Ethics Committee.

  • Provenance and peer review Not commissioned; externally peer reviewed.

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