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Heterogeneous Arterial Healing in Patients Following Paclitaxel-Eluting Stent Implantation

Comparison With Sirolimus-Eluting Stents

Masaki Awata, MD^_*, Shinsuke Nanto, MD, PhD^,_*, Masaaki Uematsu, MD, PhD^_*, Takakazu Morozumi, MD, PhD^_*, Tetsuya Watanabe, MD, PhD^_*, Toshinari Onishi, MD^_*, Osamu Iida, MD^_*, Fusako Sera, MD^_*, Hitoshi Minamiguchi, MD^_*, Jun-ichi Kotani, MD, PhD, Seiki Nagata, MD, PhD^_*

^_* Cardiovascular Division, Kansai Rosai Hospital, Amagasaki, Japan
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: We angioscopically compared paclitaxel-eluting stents (PES) and sirolimus-eluting stents (SES) to explore differences in arterial healing.

Background: Drug-eluting stents may demonstrate different arterial healing processes.

Methods: Angioscopy was performed 9 ± 2 months after 30 PES and 36 SES were implanted initially in the native coronary artery. Heterogeneity of the neointimal coverage (NIC) as well as the dominant grade was examined. Neointimal coverage was defined as follows: grade 0 = fully visible struts; grade 1 = struts bulged into the lumen, but covered; grade 2 = embedded, but translucent struts; grade 3 = invisible struts. Heterogeneity was judged when the NIC grade variation 1. Thrombi and yellow plaques (YP) were also explored.

Results: In-stent late loss (0.44 ± 0.44 mm vs. 0.13 ± 0.33 mm; p < 0.0001) and dominant NIC grade (1.8 ± 1.1 vs. 1.3 ± 0.7; p = 0.02) were greater in PES than in SES. Of PES, 48% showed the heterogeneity of 1 grade; 26% showed that of 2 grades. Of SES, 53% showed homogeneous coverage; the remaining SES showed the heterogeneity of 1 grade; and 72% showed dominant grade 1. Thrombi were more common in PES than in SES (43% vs. 19%; p = 0.04). Both stents commonly revealed YP (83% vs. 78%; p = 0.76).

Conclusions: NIC was more heterogeneous in PES, associated with a higher incidence of thrombi. Homogeneous NIC may be an important factor for competent arterial healing.

Key Words: angioscope • imaging • neointima • stent

Abbreviations and Acronyms   BMS = bare-metal stent(s)   DES = drug-eluting stent(s)   LL = late loss   LST = late stent thrombosis   NIC = neointimal coverage   PES = paclitaxel-eluting stent(s)   SES = sirolimus-eluting stent(s)   YP = yellow plaques

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