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CLINICAL RESEARCH: INTERVENTIONAL CARDIOLOGY

Characterization of Plaque Prolapse After Drug-Eluting Stent Implantation in Diabetic Patients

A Three-Dimensional Volumetric Intravascular Ultrasound Outcome Study

Hideki Futamatsu, MD, PhD^_*, Manel Sabaté, MD, PhD, Dominick J. Angiolillo, MD, PhD, FACC^_*, Pilar Jimenez-Quevedo, MD, Cecilia Corros, MD, Kino Morikawa-Futamatsu, MD^_*, Fernando Alfonso, MD, PhD, Julie Jiang^_*, Pavel Cervinka, MD, PhD^_*, Rosana Hernandez-Antolin, MD, PhD, Carlos Macaya, MD, PhD, Theodore A. Bass, MD, FACC^_* and Marco A. Costa, MD, PhD, FACC^_*,_*

^_* Division of Cardiology and Cardiovascular Imaging Core Laboratories, University of Florida, Jacksonville, Florida
Cardiovascular Institute, San Carlos University Hospital, Madrid, Spain

Manuscript received February 6, 2006; revised manuscript received April 4, 2006, accepted May 15, 2006.

^_* Reprint requests and correspondence: Dr. Marco A. Costa, Division of Cardiology and Cardiovascular Imaging Core Laboratories, University of Florida, 655 West 8th Street, Jacksonville, Florida 32209 (Email: marco.costa{at}jax.ufl.edu).

OBJECTIVES: The aim of this research was to evaluate the plaque prolapse (PP) phenomenon after bare-metal (BMS) and drug-eluting stent (DES) implantation in patients with diabetes mellitus using 3-dimensional volumetric intravascular ultrasound (IVUS).

BACKGROUND: Plaque prolapse has been observed in up to 22% of patients treated with BMS. Diabetic patients have a larger atherothrombotic burden and may be more prone to have PP. However, the incidence of PP and its clinical impact after DES implantation is unknown.

METHODS: Three-dimensional IVUS was performed after intervention and at 9-month follow-up in 168 patients with diabetes (205 lesions) treated with bare BX Velocity stents ((BX Velocity/Sonic, Cordis, Johnson & Johnson) (BMS, n = 65), sirolimus-eluting stents (Cypher, Cordis) (SES, n = 69), and paclitaxel-eluting stents (Taxus, Boston Scientific, Natick, Massachusetts) (PES, n = 71). Intravascular ultrasound data at the sites of PP were compared with stented segments without PP in each lesion. Outcomes were evaluated at 9- and 12-month follow-up.

RESULTS: There were 42 sites of PP (BMS = 11, SES = 11, PES = 20, p = NS) in 34 stented segments of 205 (16.6%) lesions. Plaque prolapse was more frequent in the right coronary artery and in chronic total occlusion lesions. Post-procedure PP volume was 1.95 mm³ in BMS, 2.96 mm³ in SES, and 4.53 mm³ in PES. At follow-up, tissue volume increased at PP sites in both BMS and PES, but not after SES. Neointimal proliferation was similar between PP and non-PP sites. Stent thrombosis and restenosis rates were similar between PP and non-PP lesions.

CONCLUSIONS: The incidence of PP after implantation of new generation tubular stents in patients with diabetes remains high. Drug-eluting stent implantation was not associated with increased risk of PP. Plaque prolapse was not associated with stent thrombosis or increased neointimal proliferation.

Abbreviations and Acronyms   BMS = bare-metal stents   CSA = cross-sectional area   DES = drug-eluting stents   DIABETES = Diabetes and Sirolimus-Eluting Stent trial   DS = diameter stenosis   EEM = external elastic membrane   IVUS = intravascular ultrasound   MLD = minimal lumen diameter   PP = plaque prolapse   3D = 3-dimensional

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