title: Randomized comparison of sirolimus and paclitaxel drug-eluting stents for long lesions in the left anterior descending artery: an intravascular ultrasound study.
abstract: OBJECTIVE
  The goal of this work was to verify whether the superiority of the sirolimus-eluting stent (SES) in inhibiting neointimal hyperplasia could be demonstrated in complex coronary lesions.
  
  
  BACKGROUND
  Both the SES (Cypher, Cordis, Miami Lakes, Florida) and the paclitaxel-eluting stent (PES) (Taxus, Boston Scientific, Natick, Massachusetts) have shown a marked reduction in neointimal hyperplasia compared with bare-metal stents. Intravascular ultrasound (IVUS) is the best method to assess arterial response to stent deployment, but few IVUS data are available comparing complex lesions treated with SES or PES.
  
  
  METHODS
  We prospectively randomized patients with complex lesions to SES or PES implantation. Intravascular ultrasound and quantitative angiography were performed post-procedure and at 9 months. Mean neointimal hyperplasia area (NIHA), percent of NIHA (NIHA%), mean peristent plaque area (PSPA), and percent of PSPA (PSPA%) were calculated. The primary end point was NIHA% at follow-up. Secondary end points included change in PSPA% and angiographic late luminal loss at follow-up.
  
  
  RESULTS
  Of the 100 patients enrolled, 42 receiving the SES and 43 receiving the PES had adequate IVUS assessment. Vessel, plaque, and lumen areas were comparable at follow-up, but NIHA% was significantly lower with SES than PES (7.4 +/- 4.2% vs. 15.4 +/- 8.1%; p < 0.001). A significant reduction in PSPA% was observed with SES (-4 +/- 10% vs. 0 +/- 8%; p = 0.01). Late loss was significantly lower with SES (0.16 +/- 0.19 mm vs. 0.32 +/- 0.33 mm; p = 0.003).
  
  
  CONCLUSIONS
  The SES shows a significantly higher inhibition of neointimal hyperplasia compared with PES in complex lesions. However, both stents have excellent IVUS and angiographic results at 9 months. A significant reduction in peri-stent plaque is observed only with SES.
authors.affiliation: Cardiology Unit, Cardiothoracic Department, University of Pisa, Pisa, Italy. a.petronio@ao-pisa.toscana.it
authors.forename: Anna Sonia
authors.initials: AS
authors.lastname: Petronio
authors.forename: Marco
authors.initials: M
authors.lastname: De Carlo
authors.forename: Giulia
authors.initials: G
authors.lastname: Branchitta
authors.forename: Barbara
authors.initials: B
authors.lastname: Papini
authors.forename: Nicola
authors.initials: N
authors.lastname: Ciabatti
authors.forename: Roberto
authors.initials: R
authors.lastname: Gistri
authors.forename: Bernardo
authors.initials: B
authors.lastname: Cortese
authors.forename: Gherardo
authors.initials: G
authors.lastname: Gherarducci
authors.forename: Antonio
authors.initials: A
authors.lastname: Barsotti
mesh_terms: D000368:Aged; D015906:Angioplasty, Balloon, Coronary; D023921:Coronary Stenosis / Q000000981:diagnostic imaging / Q000628:therapy*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D006965:Hyperplasia / Q000517:prevention & control; D007166:Immunosuppressive Agents / Q000008:administration & dosage*; D008297:Male; D008875:Middle Aged; D017239:Paclitaxel / Q000008:administration & dosage*; D011859:Radiography; D020123:Sirolimus / Q000008:administration & dosage*; D015607:Stents; D050257:Tubulin Modulators / Q000008:administration & dosage*; D017539:Tunica Intima / Q000000981:diagnostic imaging / Q000473:pathology*; D018084:Ultrasonography, Interventional
chemical_list: D007166:Immunosuppressive Agents; D050257:Tubulin Modulators; D017239:Paclitaxel; D020123:Sirolimus