Early Neointimal Coverage and Vasodilator Response Following Biodegradable Polymer Sirolimus-Eluting vs. Durable Polymer Zotarolimus-Eluting Stents in Patients With Acute Coronary Syndrome

Abstract

360KARJALAINEN PP et al. Circulation JournalOfficial Journal of the Japanese Circulation Society http://www. j-circ.or.jp inflammatory and hypersensitivity reaction leading to incomplete endothelialization following DES implantation. Localized hypersensitivity reaction has been demonstrated in the vessel wall at autopsy, and in thrombus aspirates, from patients with very late ST following first-generation DES. 4,5 Newer generation DES have thinner stent platforms, biodegradable/biocompatible polymers and rapid drug elution compared to first-generation devices. The frequency of uncovered struts was reported lower with biodegradable polymer biolimecent reports suggest a paradigm shift in the occurrence of stent thrombosis (ST) as evidenced by lower event rates in patients treated with newer generation drugeluting stents (DES) compared to bare metal stents (BMS) or first-generation DES. 1 Incomplete neointimal coverage over stent struts has been suggested as a potential substrate for late ST in histopathological studies, 2 as well as in an observational case-control setting using optical coherence tomography (OCT) in vivo. Background: Patients at high bleeding risk would benefit from a shorter dual antiplatelet therapy after PCI. Compared to first-generation devices, the design of newer generation drug-eluting stents may facilitate more rapid anatomical and functional healing of stented vessel based on thinner stent platforms, biodegradable/biocompatible polymers and rapid drug elution.

Intravascular optical coherence tomography for the evaluation of arterial bifurcations covered by flow diverters

“…Knowing when full coverage is achieved and evaluating neointimal extent may be useful in anti-aggregation regimen management, especially in resistant patients or in cases where interruption of medication is necessary 5. The in vivo method described here may be effective in the evaluation of stented ostia during follow-up when anti-aggregation regimen interruption or retreatment is needed, especially the deployment of a second stent at the level of an already narrowed jailed artery.…”

The comparison of early healing 1-month after PCI among CoCr-everolimus-eluting stent (EES), biodegradable polymer (BP)-EES and BP-sirolimus-eluting stent: Insights from OFDI and coronary angioscopy

“…However, in the present study, three stent groups already had about 80% strut coverage, which might indicate a good healing response in strut coverage. In fact, in several studies that investigated patients at 3 months after PCI, the healing outcome of these three stent types was improved [ [27] , [28] , [29] , [30] , [31] ]. Herein, there was no significant difference in OFDI findings and CAS findings, except for PLIA on OFDI.…”

Randomized Comparison of Strut Coverage between Ticagrelor and Clopidogrel in Acute Myocardial Infarction at 3-Month Optical Coherence Tomography

“…A malapposed strut was defined as a strut that had detached from the vessel wall by ≥90 µm (110 µm for stents ≥3.5 mm in diameter). 7 8 Malapposed stent was further classified into persistent, resolved, and late-acquired by matching the OCT images obtained at post-procedure and 3-month follow-up. 6 To comprehensively evaluate vascular responses, we adopted the definition of healing score as the weighted index based on OCT findings related to stent characteristics; a high score reflected higher incidence of uncovered or malapposed struts.…”