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Optimal Stent-Sizing With Intravascular Ultrasound Contributes to Complete Neointimal Coverage After Sirolimus-Eluting Stent Implantation Assessed by Angioscopy

Fusako Sera, MD^_*, Masaki Awata, MD^_*, Masaaki Uematsu, MD, PhD^_*, Jun-ichi Kotani, MD, PhD, Shinsuke Nanto, MD, PhD^_*,,_*, Seiki Nagata, MD, PhD^_*

^_* Cardiovascular Center, Kansai Rosai Hospital, Amagasaki, Japan
Department of Advanced Cardiovascular Therapeutics, Osaka University Graduate School of Medicine, Suita, Japan

^_* Reprint requests and correspondence: Prof. Shinsuke Nanto, Advanced Cardiovascular Therapeutics, Osaka University Graduate School of Medicine, 2-2 Yamadaoka, Suita 565-0871, Japan (Email: snanto{at}bca.bai.ne.jp).

Objectives: The aim of this study was to explore the determinants of neointimal coverage after sirolimus-eluting stent (SES).

Background: Although SES has significantly reduced in-stent restenosis by inhibiting neointimal hyperplasia, insufficient neointimal coverage after stenting might result in adverse outcomes.

Methods: We evaluated 28 SES lesions with both angioscopy and intravascular ultrasound (IVUS). Quantitative assessments of the lesions and stent expansion were performed by IVUS at the time of stent implantation, and degree of neointimal coverage was judged by angioscopy at follow-up (11 ± 6 months) whether the stent struts were embedded by the neointima ("complete/incomplete" neointimal coverage).

Results: "Complete" coverage was identified in 10 (36%), and "incomplete" coverage was identified in 18 (64%). Time from the stenting to angioscopy as well as the lesion and procedural characteristics were similar between the complete and incomplete coverage groups. The IVUS parameters were also similar, except for the final minimum stent cross-sectional area (CSA) (7.0 ± 1.8 mm² in complete vs. 5.3 ± 1.9 mm² in incomplete, p = 0.02) and lumen CSA at the distal reference site (6.1 ± 1.4 mm² in complete vs. 4.9 ± 1.2 mm² in incomplete, p = 0.02). The ratio of the stent area to the vessel area was significantly larger in the complete coverage than in the incomplete coverage group (0.52 ± 0.11 vs. 0.39 ± 0.09, p = 0.002).

Conclusions: Adequate stent sizing relative to the vessel size might contribute to the angioscopically complete neointimal coverage after SES implantation.

Key Words: angioscopy • intravascular ultrasound • neointima • sirolimus-eluting stent

Abbreviations and Acronyms   BMS = bare-metal stent(s)   CSA = cross-sectional area   DES = drug-eluting stent(s)   EEM = external elastic membrane   IVUS = intravascular ultrasound   MSA = minimum stent area   SES = sirolimus-eluting stent(s)

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