Advertisement

Optical coherence tomographic comparison of neointimal coverage between sirolimus- and resolute zotarolimus-eluting stents at 9 months after stent implantation

  • Jung-Sun Kim
  • Jin-Sun Kim
  • Dong-Ho Shin
  • Byeong-Keuk Kim
  • Young-Guk Ko
  • Donghoon Choi
  • Yangsoo Jang
  • Myeong-Ki Hong
Original paper

Abstract

The Resolute zotarolimus-eluting stent (ZES-R) has a thinner stent strut with biocompatible polymer than first generation drug-eluting stents. However, minimal optical coherence tomography (OCT) data exists about vascular responses after ZES-R implantation. This study investigated OCT findings in ZES-R implantation and compared them to those in sirolimus-eluting stent (SES) implantation. A total of 123 lesions (43 ZES-R and 80 SES) in 111 patients were evaluated with OCT at 9 months after stent implantation. Strut apposition, neointimal hyperplasia (NIH) thickness, and stent coverage on each stent strut were evaluated. Mean NIH thickness was significantly greater in ZES-R-treated lesions than in SES-treated lesions (166 ± 73 μm vs. 96 ± 63 μm, respectively, P < 0.001). The percentage of uncovered strut was significantly lower in ZES-R-treated lesions than in SES-treated lesions (4.4 ± 4.8% vs. 10.3 ± 13.2%, respectively, P = 0.05). The percentage of malapposed struts was also significantly lower in ZES-R-treated than in SES-treated lesions (0.1 ± 0.4% vs. 1.5 ± 4.2%, respectively, P = 0.002). Intracoronary thrombus was less frequently detected in ZES-R-treated lesions (4.7% vs. 30.0%, respectively, P = 0.001). ZES-R showed a lower incidence of uncovered or malapposed stent struts and intracoronary thrombus than SES at 9-month follow-up OCT examination. Compared with SES, ZES-R may elicit more favorable vascular responses at the expense of an increased neointimal proliferation.

Keywords

Optical coherence tomography Stent 

Notes

Acknowledgments

The authors thank Hyun Sun Lim, PhD, of the Medical Research Support Section at the Yonsei University College of Medicine for statistical support. This study was partly supported by grants from the Korea Healthcare Technology R&D Project, Ministry for Health, Welfare & Family Affairs, Republic of Korea (No. A085012 and A102064), the Korea Health 21 R&D Project, Ministry of Health & Welfare, Republic of Korea (No. A085136), and the Cardiovascular Research Center, Seoul, Korea.

Conflict of interest

None.

References

  1. 1.
    Moses JW, Leon MB, Popma JJ, Fitzgerald PJ, Holmes DR, O’Shaughnessy C, Caputo RP, Kereiakes DJ, Williams DO, Teirstein PS, Jaeger JL, Kuntz RE, for the SIRIUS investigators (2003) Sirolimus-eluting stents versus standard stents in patients with stenosis in a native coronary artery. N Engl J Med 349:1315–1323Google Scholar
  2. 2.
    Stone GW, Ellis SG, Cox DA, Hermiller J, O’Shaughnessy C, Mann JT, Turco M, Caputo R, Bergin P, Greenberg J, Popma JJ, Russell ME, TAXUS-IV investigators (2004) A polymer-based, paclitaxel-eluting stent in patients with coronary artery disease. N Engl J Med 350:221–231Google Scholar
  3. 3.
    Iakovou I, Schmidt T, Bonizzoni E, Ge L, Sangiorgi GM, Stankovic G, Airoldi F, Chieffo A, Montorfano M, Carlino M, Michev I, Corvaja N, Briguori C, Gerckens U, Grube E, Colombo A (2005) Incidence, predictors, and outcome of thrombosis after successful implantation of drug-eluting stents. JAMA 293:2126–2130PubMedCrossRefGoogle Scholar
  4. 4.
    Finn AV, Joner M, Nakazawa G, Kolodgie F, Newell J, John MC, Gold HK, Virmani R (2007) Pathological correlates of late drug-eluting stent thrombosis: strut coverage as a marker of endothelialization. Circulation 115:2435–2441PubMedCrossRefGoogle Scholar
  5. 5.
    Meredith IT, Worthley S, Whitbourn R, Walters DL, McClean D, Horrigan M, Popma JJ, Cutlip DE, DePaoli A, Negoita M, Fitzgerald PJ, RESOLUTE investigators (2009) Clinical and angiographic results with the next-generation resolute stent system: a prospective, multicenter, first-in-human trial. JACC Cardiovasc Interv 2:977–985PubMedCrossRefGoogle Scholar
  6. 6.
    Serruys PW, Silber S, Garg S, van Geuns RJ, Richardt G, Buszman PE, Kelbaek H, van Boven AJ, Hofma SH, Linke A, Klauss V, Wijns W, Macaya C, Garot P, DiMario C, Manoharan G, Kornowski R, Ischinger T, Bartorelli A, Ronden J, Bressers M, Gobbens P, Negoita M, van Leeuwen F, Windecker S (2010) Comparison of zotarolimus-eluting and everolimus-eluting coronary stents. N Engl J Med 363:136–146PubMedCrossRefGoogle Scholar
  7. 7.
    Kim U, Kim JS, Lee JM, Son JW, Kim J, Ko YG, Choi D, Jang Y (2010) The initial extent of malposition in ST-elevation myocardial infarction treated with drug-eluting stent: the usefulness of optical coherence tomography. Yonsei Med J 51:332–338PubMedCrossRefGoogle Scholar
  8. 8.
    Kim JS, Hong MK, Fan C, Kim TH, Shim JM, Park SM, Ko YG, Choi D, Jang Y (2010) Intracoronary thrombus formation after drug-eluting stents implantation: optical coherence tomographic study. Am Heart J 159:278–283PubMedCrossRefGoogle Scholar
  9. 9.
    Takano M, Inami S, Jang IK, Yamamoto M, Murakami D, Seimiya K, Ohba T, Mizuno K (2007) Evaluation by optical coherence tomography of neointimal coverage of sirolimus-eluting stent three months after implantation. Am J Cardiol 99:1033–1038PubMedCrossRefGoogle Scholar
  10. 10.
    Tanigawa J, Barlis P, De Mario C (2007) Intravascular optical coherence tomography: optimisation of image acquisition and quantitative assessment of stent strut apposition. EuroInterv 3:127–136Google Scholar
  11. 11.
    Kim JS, Jang IK, Kim JS, Kim TH, Takano M, Kume T, Hur NW, Ko YG, Choi D, Hong MK, Jang Y (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.
    Kume T, Akasaka T, Kawamoto T, Ogasawara Y, Watanabe N, Toyota E, Neishi Y, Sukmawan R, Sadahira Y, Yoshida K (2006) Assessment of coronary arterial thrombus by optical coherence tomography. Am J Cardiol 97:1713–1717PubMedCrossRefGoogle Scholar
  13. 13.
    Kim JS, Kim TH, Fan C, Lee JM, Kim W, Ko YG, Choi DH, Hong MK, Jang Y (2010) Comparison of neointimal coverage of sirolimus-eluting stents and paclitaxel-eluting stents using optical coherence tomography at 9 months after implantation. Circ J 74:320–326PubMedCrossRefGoogle Scholar
  14. 14.
    Kim JS, Jang IK, Fan C, Kim TH, Kim JS, Park SM, Choi EY, Lee SH, Ko YG, Choi D, Hong MK, Jang Y (2009) Evaluation in 3 months duration of neointimal coverage after zotarolimus-eluting stent implantation by optical coherence tomography: the ENDEAVOR OCT trial. JACC Cardiovasc Interv 2:1240–1247PubMedCrossRefGoogle Scholar
  15. 15.
    Udipi K, Melder RJ, Chen M, Cheng P, Hezi-Yamit A, Sullivan C, Wong J, Wilcox J (2007) The next generation endeavor resolute stent: role of the BioLinx Polymer System. EuroInterv 3:137–139Google Scholar
  16. 16.
    Miyazawa A, Ako J, Hongo Y, Hur SH, Tsujino I, Courtney BK, Hassan AH, Kandzari DE, Honda Y, Fitzgerald PJ, ENDEAVOR III investigators (2008) Comparison of vascular response to zotarolimus-eluting stent versus sirolimus-eluting stent: intravascular ultrasound results from ENDEAVOR III. Am Heart J 155:108–113PubMedCrossRefGoogle Scholar
  17. 17.
    Waseda K, Miyazawa A, Ako J, Hasegawa T, Tsujino I, Sakurai R, Yock PG, Honda Y, Kandzari DE, Leon MB, Fitzgerald PJ, ENDEAVOR IV trial investigators (2009) Intravascular ultrasound results from the ENDEAVOR IV trial: randomized comparison between zotarolimus- and paclitaxel-eluting stents in patients with coronary artery disease. JACC Cardiovasc Interv 2:779–784PubMedCrossRefGoogle Scholar
  18. 18.
    Waseda K, Ako J, Yamasaki M, Koizumi T, Ormiston J, Worthley SG, Whitbourn RJ, Walters DL, Honda Y, Meredith IT, Fitzgerald PJ; RESOLUTE trial investigators (2010) Short- and mid-term intravascular ultrasound analysis of the new zotarolimus-eluting stent with durable polymer - results from the RESOLUTE trial. Circ J 74:2097–2102Google Scholar
  19. 19.
    Choi HH, Kim JS, Ko YG, Hong KS, Kim TH, Kim BK, Ko YG, Choi D, Jang Y, Hong MK. Favorable neointimal coverage in everolimus-eluting stent at 9 month after stent implantation: comparison with sirolimus-eluting stent using optical coherence tomography. Int J Cardiovasc Imag (in press)Google Scholar
  20. 20.
    Inoue T, Shite J, Yoon J, Shinke T, Otake H, Sawada T, Kawamori H, Katoh H, Miyoshi N, Yoshino N, Kozuki A, Hariki H, Hirata KI (2011) Optical coherence evaluation for everolimus-eluting stents at 8 months after implantation (Cooperative Study with Korea). Heart 97:1379–1384Google Scholar
  21. 21.
    Guagliumi G, Costa MA, Sirbu V, Musumeci G, Bezerra HG, Suzuki N, Matiashvili A, Lortkipanidze N, Mihalcsik L, Trivisonno A, Valsecchi O, Mintz GS, Dressler O, Parise H, Maehara A, Cristea E, Lansky AJ, Mehran R, Stone GW (2011) Strut coverage and late malposition with paclitaxel-eluting stents compared with bare metal stents in acute myocardial infarction: optical coherence tomography substudy of the Harmonizing outcomes with revascularization and stents in acute myocardial infarction (HORIZONS-AMI) trial. Circulation 123:274–281PubMedCrossRefGoogle Scholar

Copyright information

© Springer Science+Business Media, B.V. 2011

Authors and Affiliations

  • Jung-Sun Kim
    • 1
  • Jin-Sun Kim
    • 1
  • Dong-Ho Shin
    • 1
  • Byeong-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 HospitalYonsei University College of MedicineSeodaemun-gu, SeoulKorea
  2. 2.Severance Biomedical Science InstituteYonsei University College of MedicineSeoulKorea

Personalised recommendations