Clinical Research
Interventional Cardiology
Characterization of Plaque Prolapse After Drug-Eluting Stent Implantation in Diabetic Patients: A Three-Dimensional Volumetric Intravascular Ultrasound Outcome Study

https://doi.org/10.1016/j.jacc.2006.05.050Get rights and content
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Objectives

The aim of this research was to evaluate the plaque prolapse (PP) phenomenon after bare-metal (BMS) and drug-eluting stent (DES) implantation in patients with diabetes mellitus using 3-dimensional volumetric intravascular ultrasound (IVUS).

Background

Plaque prolapse has been observed in up to 22% of patients treated with BMS. Diabetic patients have a larger atherothrombotic burden and may be more prone to have PP. However, the incidence of PP and its clinical impact after DES implantation is unknown.

Methods

Three-dimensional IVUS was performed after intervention and at 9-month follow-up in 168 patients with diabetes (205 lesions) treated with bare BX Velocity stents ((BX Velocity/Sonic, Cordis, Johnson & Johnson) (BMS, n = 65), sirolimus-eluting stents (Cypher, Cordis) (SES, n = 69), and paclitaxel-eluting stents (Taxus, Boston Scientific, Natick, Massachusetts) (PES, n = 71). Intravascular ultrasound data at the sites of PP were compared with stented segments without PP in each lesion. Outcomes were evaluated at 9- and 12-month follow-up.

Results

There were 42 sites of PP (BMS = 11, SES = 11, PES = 20, p = NS) in 34 stented segments of 205 (16.6%) lesions. Plaque prolapse was more frequent in the right coronary artery and in chronic total occlusion lesions. Post-procedure PP volume was 1.95 mm3in BMS, 2.96 mm3in SES, and 4.53 mm3in PES. At follow-up, tissue volume increased at PP sites in both BMS and PES, but not after SES. Neointimal proliferation was similar between PP and non-PP sites. Stent thrombosis and restenosis rates were similar between PP and non-PP lesions.

Conclusions

The incidence of PP after implantation of new generation tubular stents in patients with diabetes remains high. Drug-eluting stent implantation was not associated with increased risk of PP. Plaque prolapse was not associated with stent thrombosis or increased neointimal proliferation.

Abbreviations and Acronyms

BMS
bare-metal stents
CSA
cross-sectional area
DES
drug-eluting stents
DIABETES
Diabetes and Sirolimus-Eluting Stent trial
DS
diameter stenosis
EEM
external elastic membrane
IVUS
intravascular ultrasound
MLD
minimal lumen diameter
PP
plaque prolapse
3D
3-dimensional

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Dr. Hideki Futamatsu was supported by grants from the Japan Heart Foundation/Bayer Yakuhin Research Grant Abroad. Dr. Costa has received speaker fees from Cordis, Johnson & Johnson.