Long-term (≥2 years) follow-up optical coherence tomographic study after sirolimus- and paclitaxel-eluting stent implantation: comparison to 9-month follow-up results

  • Tae-Hoon Kim
  • Jung-Sun Kim
  • Byoung-Keuk Kim
  • Young-Guk Ko
  • Donghoon Choi
  • Yangsoo Jang
  • Myeong-Ki Hong
Original Paper


Many studies have demonstrated that late or very late thrombosis after drug-eluting stent (DES) implantation may be related with incomplete neointimal coverage. We investigated long-term (≥2 years) results of neointimal coverage following sirolimus-eluting stent (SES) and paclitaxel-eluting stent (PES) implantation using optical coherence tomography (OCT). A follow-up angiography with OCT examination was performed in 29 patients with 32 lesions for more than 2 years (group 1; 1,066 ± 381 days) and 101 patients with 104 lesions at 9 months (group 2; 273 ± 33 days) after the index procedure. The status of neointimal coverage and stent apposition was evaluated. The number of stents with completely covered struts was higher (25.0% in group 1 vs. 13.5% in group 2, P = 0.12). The percentage of uncovered struts (5.4 ± 7.5% in group 1 vs. 8.5 ± 11.6% in group 2, P = 0.19) and that of malapposed strut (0.5 ± 1.4% vs. 1.5 ± 4.2%, respectively, P = 0.19) were lower in group 1. While the percentage of uncovered and malapposed struts were quite similar in the PES groups between the two groups (P = 0.54 and 0.65, respectively), there were lower trends in the percentage of uncovered and malapposed struts in the SES group (P = 0.09 and 0.09, respectively). In conclusion, incomplete neointimal coverage was still observed in a majority of DESs and considerable struts were not covered with neointima even at more than 2 years after DES implantation. The pattern of neointimal coverage between 9-month and 2-year appeared to be somewhat different between PES and SES.


Stent Optical coherence tomography 



This study was partly supported by a grant of the Korea Healthcare technology R&D Project, Ministry for Health, Welfare & Family Affairs, Republic of Korea (No. A085012 and A102064), a grant of the Korea Health 21 R&D Project, Ministry of Health & Welfare, Republic of Korea (No. A085136), and the Cardiovascular Research Center, Seoul, Korea.


  1. 1.
    Babapulle MN, Joseph L, Belisle P et al (2004) A hierarchical Bayesian meta-analysis of randomised clinical trials of drug-eluting stents. Lancet 364:583–591PubMedCrossRefGoogle Scholar
  2. 2.
    Daemen J, Wenaweser P, Tsuchida K et al (2007) Early and late coronary stent thrombosis of sirolimus-eluting and paclitaxel-eluting stents in routine clinical practice: data from a large two-institutional cohort study. Lancet 369:667–678PubMedCrossRefGoogle Scholar
  3. 3.
    Joner M, Finn AV, Farb A et al (2006) Pathology of drug-eluting stents in humans: delayed healing and late thrombotic risk. J Am Coll Cardiol 48:193–202PubMedCrossRefGoogle Scholar
  4. 4.
    Kim JS, Fan C, Choi D et al. Different patterns of neointimal coverage between acute coronary syndrome and stable angina after various types of drug-eluting stents implantation; 9-month follow-up optical coherence tomography study. Int J Cardiol (in press)Google Scholar
  5. 5.
    Matsumoto D, Shite J, Shinke T et al (2007) Neointimal coverage of sirolimus-eluting stents at 6-month follow-up: evaluated by optical coherence tomography. Eur Heart J 28:961–967PubMedCrossRefGoogle Scholar
  6. 6.
    Takano M, Jang IK, Inami S et al (2008) In vivo comparison of optical coherence tomography and angioscopy for the evaluation of coronary plaque characteristics. Am J Cardiol 101:471–476PubMedCrossRefGoogle Scholar
  7. 7.
    Takano M, Inami S, Jang IK et al (2007) Evaluation by optical coherence tomography of neointimal coverage of sirolimus-eluting stent three months after implantation. Am J Cardiol 99:1033–1038PubMedCrossRefGoogle Scholar
  8. 8.
    Tanigawa J, Barlis P, Di Mario C (2007) Intravascular optical coherence tomography: optimisation of image acquisition and quantitative assessment of stent strut apposition. EuroIntervention 3:128–136PubMedGoogle Scholar
  9. 9.
    Tanigawa J, Barlis P, Dimopoulos K et al (2009) The influence of strut thickness and cell design on immediate apposition of drug-eluting stents assessed by optical coherence tomography. Int J Cardiol 134:180–188PubMedCrossRefGoogle Scholar
  10. 10.
    Kume T, Akasaka T, Kawamoto T et al (2006) Assessment of coronary arterial thrombus by optical coherence tomography. Am J Cardiol 97:1713–1717PubMedCrossRefGoogle Scholar
  11. 11.
    Kim JS, Jang IK, Kim TH et al (2009) Optical coherence tomography evaluation of zotarolimus-eluting stents at 9 month follow up: comparison with sirolimus-eluting stents. Heart 95:1907–1912PubMedCrossRefGoogle Scholar
  12. 12.
    Ong AT, Hoye A, Aoki J et al (2005) Thirty-day incidence and six-month clinical outcome of thrombotic stent occlusion after bare-metal, sirolimus, or paclitaxel stent implantation. J Am Coll Cardiol 45:947–953PubMedCrossRefGoogle Scholar
  13. 13.
    Bavry AA, Kumbhani DJ, Helton TJ et al (2005) What is the risk of stent thrombosis associated with the use of paclitaxel-eluting stents for percutaneous coronary intervention? A meta-analysis. J Am Coll Cardiol 45:941–946PubMedCrossRefGoogle Scholar
  14. 14.
    Roiron C, Sanchez P, Bouzamondo A et al (2006) Drug eluting stents: an updated meta-analysis of randomised controlled trials. Heart 92:641–649PubMedCrossRefGoogle Scholar
  15. 15.
    Lagerqvist B, James SK, Stenestrand U et al (2007) Long-term outcomes with drug-eluting stents versus bare-metal stents in Sweden. N Engl J Med 356:1009–1019PubMedCrossRefGoogle Scholar
  16. 16.
    Kaltoft A, Jensen LO, Maeng M et al (2009) 2-year clinical outcomes after implantation of sirolimus-eluting, paclitaxel-eluting, and bare-metal coronary stents: results from the WDHR (Western Denmark Heart Registry). J Am Coll Cardiol 53:658–664PubMedCrossRefGoogle Scholar
  17. 17.
    Finn AV, Joner M, Nakazawa G et al (2007) Pathological correlates of late drug-eluting stent thrombosis: strut coverage as a marker of endothelialization. Circulation 115:2435–2441PubMedCrossRefGoogle Scholar
  18. 18.
    Takano M, Yamamoto M, Inami S et al (2008) Long-term follow-up evaluation after sirolimus-eluting stent implantation by optical coherence tomography: do uncovered struts persist? J Am Coll Cardiol 51:968–969PubMedCrossRefGoogle Scholar
  19. 19.
    Park SJ, Kim YH, Kim WJ et al. Angiographic evidence of progressive lumen narrowing over 2 years following drug-eluting stent implantation. Int J Cardiol (in press)Google Scholar
  20. 20.
    Levin AD, Vukmirovic N, Hwang CW et al (2004) Specific binding to intracellular proteins determines arterial transport properties for rapamycin and paclitaxel. Proc Natl Acad Sci USA 101:9463–9467PubMedCrossRefGoogle Scholar
  21. 21.
    Perin EC (2005) Choosing a drug-eluting stent: a comparison between cypher and taxus. Rev Cardiovasc Med 6(Suppl1):S13–S21PubMedGoogle Scholar
  22. 22.
    Stone GW, Ellis SG, Cox DA et al (2004) A polymer-based, paclitaxel-eluting stent in patients with coronary artery disease. N Engl J Med 350:221–231PubMedCrossRefGoogle Scholar
  23. 23.
    Moses JW, Leon MB, Popma JJ et al (2003) Sirolimus-eluting stents versus standard stents in patients with stenosis in a native coronary artery. N Engl J Med 349:1315–1323PubMedCrossRefGoogle Scholar
  24. 24.
    Stettler C, Wandel S, Allemann S et al (2007) Outcomes associated with drug-eluting and bare-metal stents: a collaborative network meta-analysis. Lancet 370:937–948PubMedCrossRefGoogle Scholar

Copyright information

© Springer Science+Business Media, B.V. 2010

Authors and Affiliations

  • Tae-Hoon Kim
    • 1
  • Jung-Sun Kim
    • 1
  • Byoung-Keuk Kim
    • 1
  • Young-Guk Ko
    • 1
  • Donghoon Choi
    • 1
  • Yangsoo Jang
    • 1
    • 2
  • Myeong-Ki Hong
    • 1
    • 2
  1. 1.Division of Cardiology, Severance Cardiovascular CenterYonsei University College of MedicineSeoulKorea
  2. 2.Severance Biomedical Science InstituteYonsei University College of MedicineSeoulKorea

Personalised recommendations