A serial 3- and 9-year optical coherence tomography assessment of vascular healing response to sirolimus- and paclitaxel-eluting stents

Abstract

Early-generation drug-eluting stents (DES) have been demonstrated to delay vascular healing. Limited optical coherence tomography (OCT) data on the very long-term neointimal response after DES implantation are available. The aim of this study was a serial OCT assessment of neointimal thickness, stent strut coverage, malapposition, and protrusion as markers of neointimal response at 3 and 9 years after implantation of sirolimus-eluting stents (SES) and paclitaxel-eluting stents (PES). In this single-centre, longitudinal study consecutive patients undergoing elective PCI with SES or PES were included. OCT analysis was performed after 3 and 9 years by the independent core laboratory. A total of 22 subjects (8 SES and 14 PES) underwent an OCT assessment at 3 and 9 years post index procedure. The lumen, neointimal and malapposition area and the neointimal thickness (SES ∆50 µm, p = 0.195, PES ∆10 µm, p = 0.951) did not change significantly over the 6 year follow-up. No differences in the incidence of uncovered, malapposed or protruding struts were found in each type of stent. At 3 and 9 years after PCI, implantation of early-generation SES and PES may be associated with similar neointimal thickness, strut coverage, malapposition and protrusion, as assessed by serial OCT examination among patients with uneventful follow-up at 3 years post procedure. The small size of the study warrants judicious interpretation of our results and confirmation in larger multimodality imaging studies, including patients treated with contemporary stent platforms.

Final 36-Month Outcomes from the Multicenter DynamX Study Evaluating a Novel Thin-Strut Novolimus-Eluting Coronary Bioadaptor System and Supporting Preclinical Data

“…Twelve-month data have been presented previously and reported low in-device late lumen loss (0.12 0.18 mm by quantitative coronary angiography analysis), low %volume obstruction (3.39 4.66% by IVUS analysis) and nearly complete neointimal coverage (98.95 2.85% covered struts by OCT) [ 9 ]. The OCT data also showed sufficient neointimal growth to cover the bioadaptor struts with a thickness that is in the expected range for commercially available DES [ 19 , 20 ].…”

Cardiovascular imaging 2019 in the International Journal of Cardiovascular Imaging

“…Highlighting the importance of intravascular imaging, especially OCT, on guiding PCI, Tomaniak et al [18] analyzed a series of 3-and 9-year optical coherence tomography (OCT) looking at vascular healing response to sirolimus-(SES) and paclitaxel (PES) -eluting stents including 22 subjects (8 SES and 14 PES). They found that at 3 and 9 years after PCI, implantation of early-generation SES and PES may be associated with similar neointimal thickness, strut coverage, malapposition and protrusion among patients with uneventful 3 years follow-up.…”