Neointimal coverage of bare-metal and sirolimus-eluting stents evaluated with optical coherence tomography

Abstract

Objective:To analyse the neointimal coverage of sirolimus-eluting stent (SES) and bare-metal stent (BMS) visualised in vivo by optical coherence tomography (OCT).Methods:OCT images were obtained in 26 coronary vessels of 24 patients at 5–93 months after SES or BMS deployment. The short-term BMS group (BMS1) consisted of eight BMS in seven patients at 5–10 months of follow-up, the long-term BMS group (BMS2) consisted of six BMS in six patients at 23–93 months of follow-up, and the SES group (SES) consisted of 13 SES in 10 patients at 6–12 months of follow-up. The strut apposition, strut coverage and mean maximal and minimal neointimal thicknesses (NIT) for both BMS groups and SES were compared.Results:OCT images were acquired successfully. Significant differences between completely apposed and malapposed stent struts (p<0.0001) and between covered and uncovered stent struts (p<0.0001) were found among the three groups. The mean maximal and minimal NIT in the SES group were all significantly less than those of the BMS1 or BMS2 group, the minimal NIT in the BMS1 group was significantly less than that of the BMS2 but the mean maximal NIT was no significant difference between the BMS1 and BMS2 groups. In an open bifurcation artery, 19 struts visualised by OCT had no discernible coverage or were surrounded by either thrombus or a thick tissue layer.Conclusions:OCT imaging can clearly visualise stent apposition and neointimal coverage of stent struts. Incomplete strut apposition and lack of strut coverage occurred with a significantly higher frequency in SES than in BMS. These findings may explain the occurrence of late thrombosis in SES.

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“…It provides fine in vivo analysis of the 3-layer structure of the arterial wall 13 , and of atherosclerotic lesions 14 and highly sensitive thrombus detection 15 . OCT has been used since 2005 for imaging ACS-culprit lesions 16,17 and for immediate 18 and late (neointimal cover 19,20) post-procedural stent followup.…”

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“…Also, 99% of stent struts were apposed to the vessel wall (despite not using IVUS during any of the implantation procedures) and more than 90% (92.3%) were well covered with neointima. The extent of neointimal coverage was less than that of BMS (99%), 32 but similar to that of PES (92.6%) and SES (85.8%). 31 There is great interest in using OCT at stent follow-up to stratify the risk of LST, but because LST is a very rare event, there are as yet no confirmed OCT findings that predict its occurrence.…”

Tissue coverage of paclitaxel and sirolimus eluting stents in long term follow-up: Optical coherence tomography study

“…Healing pattern in different types of stents was also assessed by Chen et al [19]. They compared the neointimal stent coverage in a group of 24 patients after SES and BMS implantation [19].…”

“…They compared the neointimal stent coverage in a group of 24 patients after SES and BMS implantation [19]. In the BMS patients in whom the OCT followup was completed between 5 to 10 months post stent implantation, OCT revealed the minimal and maximal neointimal thickness of 0.2 and 0.59 mm, respectively.…”