Comparison of Neointimal Coverage by Optical Coherence Tomography of a Sirolimus-Eluting Stent Versus a Bare-Metal Stent Three Months After Implantation

doi:10.1016/j.amjcard.2008.02.091

The American Journal of Cardiology

Volume 102, Issue 1, 1 July 2008, Pages 27-31

https://doi.org/10.1016/j.amjcard.2008.02.091 Get rights and content

No detailed data regarding neointimal coverage of bare-metal stents (BMSs) at 3 months after implantation was reported to date. This investigation was designed to evaluate the neointimal coverage of BMSs compared with sirolimus-eluting stents (SESs) using optical coherence tomography. A prospective optical coherence tomographic follow-up examination was performed 3 months after stent implantation for patients who underwent BMS (n = 16) or SES implantation (n = 24). Neointimal hyperplasia (NIH) thickness on each stent strut and percentage of NIH area in each cross section were measured. Malapposition of stent struts to the vessel wall and the existence of in-stent thrombi were also evaluated. There were 5,076 struts of SESs and 2,875 struts of BMSs identified. NIH thickness and percentage of NIH area in the BMS group were higher than in the SES group (351 ± 248 vs 31 ± 39 μm; p <0.0001; 45.0 ± 14% vs 10.0 ± 4%; p <0.0001, respectively). The frequency of uncovered struts was higher in the SES group than the BMS group (15% vs 0.1%; p <0.0001). Malapposed struts were observed more frequently in the SES group than the BMS group (15% vs 1.1%; p <0.0001). In conclusion, there was no difference in incidence of in-stent thrombus between the 2 groups (14% vs 0%; p = 0.23). The present study showed almost all BMS struts to be well covered at a 3-month follow-up, suggesting that patients receiving BMS stents may not require dual-antiplatelet therapy >3 months after implantation.

Section snippets

Methods

Twenty-four patients (24 lesions) undergoing implantation of an SES (Cypher; Cordis Corp., Miami Lakes, Florida) from December 2005 to March 2006 and 16 patients (16 lesions) treated using a BMS (Multilink Vision; Guidant Corp., Santa Clara, California; Liberté; Boston Scientific Corp., Natick, Massachusetts; or S-stent; Biosensors Int., Newport Beach, California) from April 2007 to July 2007 in native coronary arteries were identified as the SES and BMS groups, respectively. We previously

Results

Clinical characteristics of the study population are listed in Table 1. The BMS group had larger reference diameters, and accordingly, the stent diameter of the BMS (n = 18) was larger than that of the SES (n = 38; 3.3 ± 0.4 vs 2.9 ± 0.4 mm; p = 0.001). Stent segment length was shorter in BMS group than the SES group. The BMS group tended to show an increased rate of restenosis in comparison to the SES group. The rates were not statistically significant.

There were no optical coherence

Discussion

Pathologic research showed that incomplete neointimal coverage of stent struts is the most powerful morphometric predictor of late stent thrombosis.⁷ Recent angioscopic studies also showed that thrombi were commonly seen in SESs with incomplete neointimal coverage.8, 9 Therefore, to confirm complete neointimal coverage after stent implantation is clinically important.

There were reports that used OCT to show that neointimal coverage over an SES was incomplete 3 to 6 months after implantation.1, 2

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Biodegradable magnesium and its alloys have attracted much attention, as they have been used as cardiovascular stents recently because of their biodegradation after implantation. However, their corrosion resistance, hemocompatibility and surface biocompatibility are needed for practical applications. In this work, heparinization of the plasma electrolytic oxidation/poly(l-lactic acid) (PEO/PLLA) composite coating on biodegradable AZ31 alloy was achieved by the strong adhesion of mussel-inspired polydopamine (PDAM). The corrosion resistance of the coated substrates was evaluated in simulated body fluid. In particular, the hemolysis ratio and platelet adhesion tests were conducted to evaluate the hemocompatibility of the composite coatings. The in vitro cytotoxicity of the composite coatings was evaluated with human umbilical vein endothelial cells (HUVECs). The adhesion and proliferation of HUVECs and human umbilical artery smooth muscle cells (HUASMCs) directly incubated on the composite coatings were also investigated. The results showed that although PDAM modification and further heparinization reduced the corrosion resistance of the PEO/PLLA composite coating, the protection of the coating for the substrate was mainly maintained. Moreover, PDAM modification and further heparinization significantly suppressed the adhesion of platelets and had little influence on sustaining a low hemolysis ratio thus resulting in good surface hemocompatibility of the composite coating. The in vitro cell test demonstrated that none of the composite coatings presented obvious cytotoxicity. Significantly, after surface heparinization, the composite coating became more suitable for HUVEC growth and simultaneously inhibited HUASMC growth. The results show that further modification of the PEO/PLLA composite coating on biodegradable magnesium alloy is a promising method to obtain good surface hemocompatibility for anticoagulation and to regulate the cell fate for fast re-endothelialization while sustaining the corrosion resistance of biodegradable magnesium-based cardiovascular stents.
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: This work was supported in part by the Japan-China Sasakawa Medical Fellowship, Tokyo, Japan.

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Coronary artery diseaseComparison of Neointimal Coverage by Optical Coherence Tomography of a Sirolimus-Eluting Stent Versus a Bare-Metal Stent Three Months After Implantation

Section snippets

Methods

Results

Discussion

Am J Cardiol

J Am Coll Cardiol

J Am Coll Cardiol

J Am Coll Cardiol

J Am Coll Cardiol

J Am Coll Cardiol

J Am Coll Cardiol

Neointimal coverage of sirolimus-eluting stents at 6-month follow-up: evaluated by optical coherence tomography

Eur Heart J

Circulation

Coronary artery disease
Comparison of Neointimal Coverage by Optical Coherence Tomography of a Sirolimus-Eluting Stent Versus a Bare-Metal Stent Three Months After Implantation