Document Detail

Optical coherence tomography assessment of in vivo vascular response after implantation of overlapping bare-metal and drug-eluting stents.
MedLine Citation:
PMID:  20488410     Owner:  NLM     Status:  MEDLINE    
OBJECTIVES: We designed a randomized trial exploiting optical coherence tomography (OCT) to assess coverage and apposition of overlapping bare-metal stents (BMS) and drug-eluting stents (DES) in human coronary arteries.
BACKGROUND: Overlapping DES impair healing in animals. Optical coherence tomography allows accurate in vivo assessment of stent strut coverage and apposition.
METHODS: Seventy-seven patients with long coronary stenoses were randomized to overlapping sirolimus-eluting stents (SES), paclitaxel-eluting stents (PES), zotarolimus-eluting stents (ZES), or BMS. The primary goal of the study was to determine the rate of uncovered/malapposed struts in overlap versus nonoverlap segments, according to stent type, at 6-month follow-up with OCT.
RESULTS: A total of 53,047 struts were analyzed. The rate of uncovered/malapposed struts was 1.5 +/- 3.4% and 0.6 +/- 2.7% in overlap versus nonoverlap BMS (p = NS), respectively, and 4.3 +/- 11% and 3.6 +/- 8% in overlap versus nonoverlap DES (p = NS), respectively. There were no differences in the rates of uncovered/malapposed struts between overlapping BMS and DES, likely due to low frequency of uncovered/malapposed struts in ZES (0.1 +/- 0.4%), which offset the higher rates observed in SES (6.7 +/- 9.6%) and PES (6.7 +/- 16.5%, p < 0.05). Overlap segments showed greater neointimal volume obstruction versus nonoverlap segments in all DES (p < 0.05 for all DES types). Strut-level neointimal thickness at overlap and nonoverlap segments were lowest in SES (0.16 +/- 0.1 mm and 0.12 +/- 0.1 mm, respectively) compared with PES (0.27 +/- 0.1 mm and 0.20 +/- 0.1 mm, respectively), ZES (0.40 +/- 0.16 mm and 0.33 +/- 0.13 mm, respectively), and BMS (0.55 +/- 0.31 mm and 0.53 +/- 0.25 mm, respectively, p < 0.05).
CONCLUSIONS: As assessed by OCT the impact of DES on vascular healing was similar at overlapping and nonoverlapping sites. However, strut malapposition, coverage pattern, and neointimal hyperplasia differ significantly according to DES type. (Optical Coherence Tomography for Drug Eluting Stent Safety [ODESSA]; NCT00693030).
Giulio Guagliumi; Giuseppe Musumeci; Vasile Sirbu; Hiram G Bezerra; Nobuaki Suzuki; Luigi Fiocca; Aleksandre Matiashvili; Nikoloz Lortkipanidze; Antonio Trivisonno; Orazio Valsecchi; Giuseppe Biondi-Zoccai; Marco A Costa;
Publication Detail:
Type:  Journal Article; Randomized Controlled Trial; Research Support, Non-U.S. Gov't    
Journal Detail:
Title:  JACC. Cardiovascular interventions     Volume:  3     ISSN:  1876-7605     ISO Abbreviation:  JACC Cardiovasc Interv     Publication Date:  2010 May 
Date Detail:
Created Date:  2010-05-21     Completed Date:  2010-08-30     Revised Date:  2014-09-05    
Medline Journal Info:
Nlm Unique ID:  101467004     Medline TA:  JACC Cardiovasc Interv     Country:  United States    
Other Details:
Languages:  eng     Pagination:  531-9     Citation Subset:  IM    
Copyright Information:
Copyright 2010 American College of Cardiology Foundation. Published by Elsevier Inc. All rights reserved.
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MeSH Terms
Aged, 80 and over
Angioplasty, Balloon, Coronary / adverse effects,  instrumentation*
Cardiovascular Agents / administration & dosage*
Coronary Angiography
Coronary Stenosis / pathology,  therapy*
Coronary Vessels / pathology*
Drug-Eluting Stents*
Feasibility Studies
Middle Aged
Paclitaxel / administration & dosage
Predictive Value of Tests
Prospective Studies
Prosthesis Design
Sirolimus / administration & dosage,  analogs & derivatives
Time Factors
Tomography, Optical Coherence*
Treatment Outcome
Ultrasonography, Interventional
Reg. No./Substance:
0/Cardiovascular Agents; 0/Metals; 0/zotarolimus; 33069-62-4/Paclitaxel; W36ZG6FT64/Sirolimus

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