Advertisement

The International Journal of Cardiovascular Imaging

, Volume 29, Issue 8, pp 1909–1913 | Cite as

Scanning electron microscopic analysis of polymer damage in drug-eluting stents during multiple stenting

  • Aiko Shimokado
  • Takashi Kubo
  • Hirotoshi Utsunomiya
  • Hisashi Yamasaki
  • Takashi Tanimoto
  • Yasushi Ino
  • Yong Liu
  • Ikuko Teraguchi
  • Yuichi Ozaki
  • Yasutsugu Shiono
  • Makoto Orii
  • Kunihiro Shimamura
  • Takashi Yamano
  • Tomoyuki Yamaguchi
  • Kumiko Hirata
  • Toshio Imanishi
  • Takashi Akasaka
Original Paper

Abstract

Polymer damage of drug-eluting stents (DES) during percutaneous coronary intervention procedure could be associated with stent restenosis. We assessed the damage to the drug-containing polymer of DES during multiple stenting in a phantom model by using scanning-electron microscopy (SEM). Unexpanded sirolimus-eluting stent (SES; n = 15) was delivered through the formerly expanded SES (n = 15) in a bended polytetrafluoroethylene plastic tube. The stent was subcategorized into 4 segments (S), including distal (S1), mid distal (S2), mid proximal (S3) and proximal segments (S4), for qualitative SEM assessment. Polymer damage, such as detachments, missing or tears, was observed not only in the outer surface of the unexpanded stents (100 %) but also in the inner surface of the formerly expanded stents (100 %). There was a significant difference in the frequency of polymer damage among the 4 segments in the unexpanded stents (S1 vs. S2 vs. S3 vs. S4: 86.7 vs. 80.0 vs. 53.3 vs. 40.0 %, p = 0.022) and the formerly expanded stents (S1 vs. S2 vs. S3 vs. S4: 80.0 vs. 73.3 vs. 73.3 vs. 40.0 %, p = 0.041). The damage was distributed more frequently in distal part than proximal part of either unexpanded stents (S1 vs. S4, p = 0.0079) and the formerly expanded stents (S1 vs. S4, p = 0.0079). Delivery of DES through a formerly expanded DES could cause damage to drug-containing polymer of the stents.

Keywords

Drug-eluting stent Polymer damage Scanning electron microscopy Stent analysis 

Notes

Conflict of interest

All authors, do not have a financial interest/arrangement or affiliation with one or more organizations that could be perceived as a real or apparent conflict of interest in the context of the subject of this article.

Supplementary material

10554_2013_289_MOESM1_ESM.doc (1 mb)
Supplementary material 1 (DOC 1045 kb)

References

  1. 1.
    Serruys PW, Kutryk MJ, Ong AT (2006) Coronary-artery stents. N Engl J Med 354(5):483–495. doi: 10.1056/NEJMra051091 PubMedCrossRefGoogle Scholar
  2. 2.
    Morice MC, Serruys PW, Sousa JE, Fajadet J, Ban Hayashi E, Perin M, Colombo A, Schuler G, Barragan P, Guagliumi G, Molnar F, Falotico R (2002) A randomized comparison of a sirolimus-eluting stent with a standard stent for coronary revascularization. N Engl J Med 346(23):1773–1780. doi: 10.1056/NEJMoa012843 PubMedCrossRefGoogle Scholar
  3. 3.
    Kastrati A, Mehilli J, Pache J, Kaiser C, Valgimigli M, Kelbaek H, Menichelli M, Sabate M, Suttorp MJ, Baumgart D, Seyfarth M, Pfisterer ME, Schomig A (2007) Analysis of 14 trials comparing sirolimus-eluting stents with bare-metal stents. N Engl J Med 356(10):1030–1039. doi: 10.1056/NEJMoa067484 PubMedCrossRefGoogle Scholar
  4. 4.
    Stettler C, Wandel S, Allemann S, Kastrati A, Morice MC, Schomig A, Pfisterer ME, Stone GW, Leon MB, de Lezo JS, Goy JJ, Park SJ, Sabate M, Suttorp MJ, Kelbaek H, Spaulding C, Menichelli M, Vermeersch P, Dirksen MT, Cervinka P, Petronio AS, Nordmann AJ, Diem P, Meier B, Zwahlen M, Reichenbach S, Trelle S, Windecker S, Juni P (2007) Outcomes associated with drug-eluting and bare-metal stents: a collaborative network meta-analysis. Lancet 370(9591):937–948. doi: 10.1016/S0140-6736(07)61444-5 PubMedCrossRefGoogle Scholar
  5. 5.
    Shirai S, Kimura T, Nobuyoshi M, Morimoto T, Ando K, Soga Y, Yamaji K, Kondo K, Sakai K, Arita T, Goya M, Iwabuchi M, Yokoi H, Nosaka H, Mitsudo K (2010) Impact of multiple and long sirolimus-eluting stent implantation on 3-year clinical outcomes in the j-Cypher Registry. JACC Cardiovasc Interv 3(2):180–188. doi: 10.1016/j.jcin.2009.11.009 PubMedCrossRefGoogle Scholar
  6. 6.
    Kuriyama N, Kobayashi Y, Nakayama T, Kuroda N, Komuro I (2006) Images in cardiovascular medicine. Damage to polymer of a sirolimus-eluting stent. Circulation 114(20):e586–e587. doi: 10.1161/CIRCULATIONAHA.106.637363 Google Scholar
  7. 7.
    Wiemer M, Butz T, Schmidt W, Schmitz KP, Horstkotte D, Langer C (2010) Scanning electron microscopic analysis of different drug eluting stents after failed implantation: from nearly undamaged to major damaged polymers. Catheter Cardiovasc Interv Off J Soc Cardiac Angiogr Interv 75(6):905–911. doi: 10.1002/ccd.22347 Google Scholar
  8. 8.
    Otsuka Y, Chronos NA, Apkarian RP, Robinson KA (2007) Scanning electron microscopic analysis of defects in polymer coatings of three commercially available stents: comparison of BiodivYsio, Taxus and Cypher stents. J Invasive Cardiol 19(2):71–76PubMedGoogle Scholar
  9. 9.
    Basalus MW, Tandjung K, van Westen T, Sen H, van der Jagt PK, Grijpma DW, van Apeldoorn AA, von Birgelen C (2012) Scanning electron microscopic assessment of coating irregularities and their precursors in unexpanded durable polymer-based drug-eluting stents. Catheter Cardiovasc Interv Off J Soc Cardiac Angiogr Interv 79(4):644–653. doi: 10.1002/ccd.23273 CrossRefGoogle Scholar
  10. 10.
    Lemos PA, Hoye A, Goedhart D, Arampatzis CA, Saia F, van der Giessen WJ, McFadden E, Sianos G, Smits PC, Hofma SH, de Feyter PJ, van Domburg RT, Serruys PW (2004) Clinical, angiographic, and procedural predictors of angiographic restenosis after sirolimus-eluting stent implantation in complex patients: an evaluation from the Rapamycin-Eluting Stent Evaluated At Rotterdam Cardiology Hospital (RESEARCH) study. Circulation 109(11):1366–1370. doi: 10.1161/01.CIR.0000121358.26097.06 PubMedCrossRefGoogle Scholar
  11. 11.
    Nakagawa Y, Kimura T, Morimoto T, Nomura M, Saku K, Haruta S, Muramatsu T, Nobuyoshi M, Kadota K, Fujita H, Tatami R, Shiode N, Nishikawa H, Shibata Y, Miyazaki S, Murata Y, Honda T, Kawasaki T, Doi O, Hiasa Y, Hayashi Y, Matsuzaki M, Mitsudo K (2010) Incidence and risk factors of late target lesion revascularization after sirolimus-eluting stent implantation (3-year follow-up of the j-Cypher Registry). Am J Cardiol 106(3):329–336. doi: 10.1016/j.amjcard.2010.03.031
  12. 12.
    Guagliumi G, Musumeci G, Sirbu V, Bezerra HG, Suzuki N, Fiocca L, Matiashvili A, Lortkipanidze N, Trivisonno A, Valsecchi O, Biondi-Zoccai G, Costa MA (2010) Optical coherence tomography assessment of in vivo vascular response after implantation of overlapping bare-metal and drug-eluting stents. JACC Cardiovasc Interv 3(5):531–539. doi: 10.1016/j.jcin.2010.02.008 PubMedCrossRefGoogle Scholar

Copyright information

© Springer Science+Business Media Dordrecht 2013

Authors and Affiliations

  • Aiko Shimokado
    • 1
  • Takashi Kubo
    • 1
  • Hirotoshi Utsunomiya
    • 2
  • Hisashi Yamasaki
    • 3
  • Takashi Tanimoto
    • 1
  • Yasushi Ino
    • 1
  • Yong Liu
    • 1
  • Ikuko Teraguchi
    • 1
  • Yuichi Ozaki
    • 1
  • Yasutsugu Shiono
    • 1
  • Makoto Orii
    • 1
  • Kunihiro Shimamura
    • 1
  • Takashi Yamano
    • 1
  • Tomoyuki Yamaguchi
    • 1
  • Kumiko Hirata
    • 1
  • Toshio Imanishi
    • 1
  • Takashi Akasaka
    • 1
  1. 1.Department of Cardiovascular MedicineWakayama Medical UniversityWakayamaJapan
  2. 2.Department of Internal MedicineWakayama Medical UniversityWakayamaJapan
  3. 3.Division of BiologyWakayama Medical UniversityWakayamaJapan

Personalised recommendations