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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