Characterization of plaque prolapse after drug-eluting stent implantation in diabetic patients: a three-dimensional volumetric intravascular ultrasound outcome study.
OBJECTIVE
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.
Futamatsu
Hideki
H
Division of Cardiology and Cardiovascular Imaging Core Laboratories, University of Florida, Jacksonville, Florida 32209, USA.
Sabaté
Manel
M
Angiolillo
Dominick J
DJ
Jimenez-Quevedo
Pilar
P
Corros
Cecilia
C
Morikawa-Futamatsu
Kino
K
Alfonso
Fernando
F
Jiang
Julie
J
Cervinka
Pavel
P
Hernandez-Antolin
Rosana
R
Macaya
Carlos
C
Bass
Theodore A
TA
Costa
Marco A
MA
D000368:Aged; D002908:Chronic Disease; D003327:Coronary Disease / Q000000981:diagnostic imaging / Q000628:therapy; D023921:Coronary Stenosis / Q000000981:diagnostic imaging* / Q000628:therapy; D003925:Diabetic Angiopathies / Q000000981:diagnostic imaging* / Q000628:therapy; D016503:Drug Delivery Systems / Q000009:adverse effects*; D004867:Equipment Design; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D021621:Imaging, Three-Dimensional; D008297:Male; D008670:Metals; D008875:Middle Aged; D015337:Multicenter Studies as Topic; D017239:Paclitaxel / Q000008:administration & dosage / Q000627:therapeutic use; D011391:Prolapse; D016032:Randomized Controlled Trials as Topic; D018570:Risk Assessment; D020123:Sirolimus / Q000008:administration & dosage / Q000627:therapeutic use; D015607:Stents / Q000009:adverse effects*; D016896:Treatment Outcome; D018084:Ultrasonography, Interventional
D008670:Metals; D017239:Paclitaxel; D020123:Sirolimus