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CLINICAL RESEARCH: INTERVENTIONAL CARDIOLOGY

Evaluation of Four-Year Coronary Artery Response After Sirolimus-Eluting Stent Implantation Using Serial Quantitative Intravascular Ultrasound and Computer-Assisted Grayscale Value Analysis for Plaque Composition in Event-Free Patients

Jiro Aoki, MD^_*, Alexandre C. Abizaid, MD, PhD, FACC, Patrick W. Serruys, MD, PhD, FACC^_*,_*, Andrew T.L. Ong, MBBS, FRACP^_*, Eric Boersma, PhD^_*, J. Eduardo Sousa, MD, PhD, FACC and Nico Bruining, PhD^_*

^_* Erasmus Medical Center, Rotterdam, the Netherlands
Institute Dante Pazzanese of Cardiology, São Paulo, Brazil.

Manuscript received December 9, 2004; revised manuscript received June 22, 2005, accepted June 28, 2005.

^_* Reprint requests and correspondence: Dr. Patrick W. Serruys, Thoraxcenter, Bd 406, Erasmus Medical Center, Dr Molewaterplein 40, 3015 GD Rotterdam, the Netherlands. (Email: p.w.j.c.serruys{at}erasmusmc.nl).

OBJECTIVES: This study sought to evaluate the long-term arterial response after sirolimus-eluting stent implantation.

BACKGROUND: Sirolimus-eluting stents are effective in inhibiting neointimal hyperplasia without affecting plaque volume behind the stent struts at six months.

METHODS: Serial quantitative intravascular ultrasound and computer-assisted grayscale value analysis over four years were performed in 23 event-free patients treated with sirolimus-eluting stents.

RESULTS: In the first two years, the mean plaque volume (155.5 ± 42.8 mm³ post-procedure and 156.8 ± 57.7 mm³ at two years, p = 0.86) and plaque compositional change expressed as mean percent hypoechogenic tissue of the plaque behind the stent struts (78.9 ± 8.6% post-procedure and 78.2 ± 8.9% at two years, p = 0.67) did not significantly change. However, significant plaque shrinking (change in plaque volume = –18.4 mm³, p = 0.02) with an increase in plaque echogenicity (change in percent hypoechogenic tissue = –7.8%, p < 0.0001) was observed between two and four years. The mean neointimal volume increased over four years from 0 to 8.4 ± 5.8 mm³ (p < 0.0001). However, no further statistically significant change occurred between two and four years (7.0 ± 6.7 mm³ vs. 8.4 ± 5.8 mm³, p = 0.25).

CONCLUSIONS: Between two and four years after sirolimus-eluting stent implantation, peri-stent tissue shrank with a concomitant increase in echogenicity. These intravascular ultrasound findings suggest that late chronic artery responses may evolve for up to four years after sirolimus-eluting stent implantation. In addition, the fact that the neointima does not significantly change from two to four years may suggest that the biological phenomenon of a delayed healing response has begun to subside.

Abbreviations and Acronyms   ANOVA = analysis of variance   ECG = electrocardiogram/electrocardiographic   IVUS = intravascular ultrasound   PES = paclitaxel-eluting stent   SES = sirolimus-eluting stent

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