EXPEDITED REVIEW
Incomplete Neointimal Coverage of Sirolimus-Eluting Stents
Angioscopic Findings
Jun-ichi Kotani, MD, FACC*,*,
Masaki Awata, MD*,
Shinsuke Nanto, MD*,
Masaaki Uematsu, MD, FACC*,
Fusako Oshima, MD*,
Hitoshi Minamiguchi, MD*,
Gary S. Mintz, MD, FACC and
Seiki Nagata, MD*
* Cardiovascular Division, Kansai Rosai Hospital, Amagasaki, Japan
Cardiovascular Research Foundation, New York, New York
Manuscript received July 31, 2005;
revised manuscript received September 19, 2005,
accepted November 1, 2005.
* Reprint requests and correspondence: Dr. Jun-ichi Kotani, Kansai Rosai Hospital, 3-1-69 Inabaso, Amagasaki, 660-8511 Japan. (Email: shamallv8{at}aol.com).
OBJECTIVES: The goal of this study was to use angioscopy to investigate the amount of neointimal coverage after sirolimus-eluting stent (SES) implantation.
BACKGROUND: Sirolimus-eluting stents reduce intimal hyperplasia.
METHODS: We used angioscopy to evaluate 37 consecutive stented coronary artery lesions (15 SES and 22 bare-metal stents [BMS]) in 25 patients (18 men, 7 women) at 3 to 6 months after stent implantation. Angioscopic evaluation focused on: 1) neointimal coverage of stent struts, and 2) the existence of thrombi. The degree of neointimal coverage was classified as grade 0 when there was no neointimal coverage (similar to immediately after the implantation); grade 1 when stent struts bulged into the lumen, but were covered and still translucently visible; grade 2 when stent struts were visible but not clearly seen (not translucent); and grade 3 when stent struts were not visible because they were embedded in the neointima.
RESULTS: Thrombi were identified in eight stented segments, tended to be more common with SES (p = 0.14), but were not seen on angiography. Three of the 15 SES (20%) had grade 0 neointimal coverage, and only 2 SES (13.3%) had complete coverage (grades 2/3). In contrast, all 22 BMS showed complete intimal coverage (grades 2/3). Thrombi were more common in stents with incomplete neointimal coverage (p = 0.09).
CONCLUSIONS: The SES had incomplete neointimal coverage three to six months after implantation, and this was associated with subclinical thrombus formation.
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Abbreviations and Acronyms
| | BMS = bare-metal stent | | IVUS = intravascular ultrasound | | SES = sirolimus-eluting stent | | VBT = vascular brachytherapy |
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T. G. Nuhrenberg, N. Langwieser, J. B.K. Schwarz, Y. Hou, P. Frank, F. Sorge, S. Matschurat, S. Seidl, A. Kastrati, A. Schomig, et al.
EMAP-II downregulation contributes to the beneficial effects of rapamycin after vascular injury
Cardiovasc Res,
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580 - 589.
[Abstract]
[Full Text]
[PDF]
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B. Doyle, C. S. Rihal, C. J. O'Sullivan, R. J. Lennon, H. J. Wiste, M. Bell, J. Bresnahan, and D. R. Holmes Jr
Outcomes of Stent Thrombosis and Restenosis During Extended Follow-Up of Patients Treated With Bare-Metal Coronary Stents
Circulation,
November 20, 2007;
116(21):
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[Abstract]
[Full Text]
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S. Windecker and B. Meier
Late Coronary Stent Thrombosis
Circulation,
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A. E. Rodriguez, A. O. Maree, J. Mieres, D. Berrocal, L. Grinfeld, C. Fernandez-Pereira, V. Curotto, A. Rodriguez-Granillo, W. O'Neill, and I. F. Palacios
Late loss of early benefit from drug-eluting stents when compared with bare-metal stents and coronary artery bypass surgery: 3 years follow-up of the ERACI III registry
Eur. Heart J.,
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[Abstract]
[Full Text]
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P.-G. Chassot, A. Delabays, and D. R. Spahn
Perioperative antiplatelet therapy: the case for continuing therapy in patients at risk of myocardial infarction
Br. J. Anaesth.,
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[Abstract]
[Full Text]
[PDF]
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J. Daemen and P. W. Serruys
Drug-Eluting Stent Update 2007: Part II: Unsettled Issues
Circulation,
August 21, 2007;
116(8):
961 - 968.
[Full Text]
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M. Awata, J.-i. Kotani, M. Uematsu, T. Morozumi, T. Watanabe, T. Onishi, O. Iida, F. Sera, S. Nanto, M. Hori, et al.
Serial Angioscopic Evidence of Incomplete Neointimal Coverage After Sirolimus-Eluting Stent Implantation: Comparison With Bare-Metal Stents
Circulation,
August 21, 2007;
116(8):
910 - 916.
[Abstract]
[Full Text]
[PDF]
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J. L. Anderson, C. D. Adams, E. M. Antman, C. R. Bridges, R. M. Califf, D. E. Casey Jr, W. E. Chavey II, F. M. Fesmire, J. S. Hochman, T. N. Levin, et al.
ACC/AHA 2007 Guidelines for the Management of Patients With Unstable Angina/Non-ST-Elevation Myocardial Infarction: A Report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (Writing Committee to Revise the 2002 Guidelines for the Management of Patients With Unstable Angina/Non-ST-Elevation Myocardial Infarction) Developed in Collaboration with the American College of Emergency Physicians, the Society for Cardiovascular Angiography and Interventions, and the Society of Thoracic Surgeons Endorsed by the American Association of Cardiovascular and Pulmonary Rehabilitation and the Society for Academic Emergency Medicine
J. Am. Coll. Cardiol.,
August 14, 2007;
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[Full Text]
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J. L. Anderson, C. D. Adams, E. M. Antman, C. R. Bridges, R. M. Califf, D. E. Casey Jr, W. E. Chavey II, F. M. Fesmire, J. S. Hochman, T. N. Levin, et al.
ACC/AHA 2007 Guidelines for the Management of Patients With Unstable Angina/Non ST-Elevation Myocardial Infarction Executive Summary: A Report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (Writing Committee to Revise the 2002 Guidelines for the Management of Patients With Unstable Angina/Non ST-Elevation Myocardial Infarction) Developed in Collaboration with the American College of Emergency Physicians, the Society for Cardiovascular Angiography and Interventions, and the Society of Thoracic Surgeons Endorsed by the American Association of Cardiovascular and Pulmonary Rehabilitation and the Society for Academic Emergency Medicine
J. Am. Coll. Cardiol.,
August 14, 2007;
50(7):
652 - 726.
[Full Text]
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M. R Bennett
Vascular pathology as a result of drug-eluting stents
Heart,
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93(8):
895 - 896.
[Abstract]
[Full Text]
[PDF]
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C. Bode and M. Zehender
The use of antiplatelet agents following percutaneous coronary intervention: focus on late stent thrombosis
Eur. Heart J. Suppl.,
August 1, 2007;
9(suppl_D):
D10 - D19.
[Abstract]
[Full Text]
[PDF]
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S. R. Dixon, C. L. Grines, and W. W. O'Neill
The Year in Interventional Cardiology
J. Am. Coll. Cardiol.,
July 17, 2007;
50(3):
270 - 285.
[Full Text]
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R. Jaffe and B. H. Strauss
Late and Very Late Thrombosis of Drug-Eluting Stents: Evolving Concepts and Perspectives
J. Am. Coll. Cardiol.,
July 10, 2007;
50(2):
119 - 127.
[Abstract]
[Full Text]
[PDF]
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D. R. Holmes Jr, D. J. Kereiakes, W. K. Laskey, A. Colombo, S. G. Ellis, T. D. Henry, J. J. Popma, P. W.J.C. Serruys, T. Kimura, D. O. Williams, et al.
Thrombosis and Drug-Eluting Stents: An Objective Appraisal
J. Am. Coll. Cardiol.,
July 10, 2007;
50(2):
109 - 118.
[Abstract]
[Full Text]
[PDF]
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A. V. Finn, G. Nakazawa, M. Joner, F. D. Kolodgie, E. K. Mont, H. K. Gold, and R. Virmani
Vascular Responses to Drug Eluting Stents: Importance of Delayed Healing
Arterioscler Thromb Vasc Biol,
July 1, 2007;
27(7):
1500 - 1510.
[Abstract]
[Full Text]
[PDF]
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D. Matsumoto, J. Shite, T. Shinke, H. Otake, Y. Tanino, D. Ogasawara, T. Sawada, O. L. Paredes, K.-i. Hirata, and M. Yokoyama
Neointimal coverage of sirolimus-eluting stents at 6-month follow-up: evaluated by optical coherence tomography
Eur. Heart J.,
April 2, 2007;
28(8):
961 - 967.
[Abstract]
[Full Text]
[PDF]
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B. J.G.L. de Smet and F. Zijlstra
A look at drug eluting stents with optical coherence tomography
Eur. Heart J.,
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E. Camenzind, P. G. Steg, and W. Wijns
A Cause for Concern
Circulation,
March 20, 2007;
115(11):
1440 - 1455.
[Full Text]
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H.-P. B.-L. Rocca, C. Kaiser, M. Pfisterer, and on behalf of the BASKET Investigators
Targeted stent use in clinical practice based on evidence from the BAsel Stent Cost Effectiveness Trial (BASKET)
Eur. Heart J.,
March 2, 2007;
28(6):
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[Abstract]
[Full Text]
[PDF]
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D. I. Simon and V. J. Pompili
Far-Fetched Benefit of Inflammation
Circulation,
February 6, 2007;
115(5):
548 - 549.
[Full Text]
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A. N. DeMaria, O. Ben-Yehuda, G. K. Feld, G. S. Ginsburg, B. H. Greenberg, W. Y.W. Lew, J. A.C. Lima, A. S. Maisel, J. Narula, D. J. Sahn, et al.
Highlights of the Year in JACC 2006
J. Am. Coll. Cardiol.,
January 30, 2007;
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[Full Text]
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D. J. Kereiakes
Does Clopidogrel Each Day Keep Stent Thrombosis Away?
JAMA,
January 10, 2007;
297(2):
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[Full Text]
[PDF]
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M. Pfisterer, H. P. Brunner-La Rocca, P. T. Buser, P. Rickenbacher, P. Hunziker, C. Mueller, R. Jeger, F. Bader, S. Osswald, C. Kaiser, et al.
Late Clinical Events After Clopidogrel Discontinuation May Limit the Benefit of Drug-Eluting Stents: An Observational Study of Drug-Eluting Versus Bare-Metal Stents
J. Am. Coll. Cardiol.,
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[Abstract]
[Full Text]
[PDF]
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P. J. Geraghty
Bioabsorbable Stenting for Peripheral Arterial Occlusive Disease
Perspectives in Vascular Surgery and Endovascular Therapy,
December 1, 2006;
18(4):
295 - 298.
[Abstract]
[PDF]
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S. Tsimikas
Drug-Eluting Stents and Late Adverse Clinical Outcomes: Lessons Learned, Lessons Awaited
J. Am. Coll. Cardiol.,
May 16, 2006;
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[Full Text]
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