Intravascular ultrasound findings in patients with restenosis of sirolimus- and paclitaxel-eluting stents.
OBJECTIVE
We used intravascular ultrasound (IVUS) to compare restenotic sirolimus-eluting (SES) vs paclitaxel-eluting (PES) stents.


BACKGROUND
Little is known about the IVUS pattern and mechanisms of restenosis, in the two widely available drug-eluting stent (DES) platforms.


METHODS
Volumetric IVUS analysis was performed in patients with clinical restenosis in DES (n=29 SES and 11 PES respectively).


RESULTS
Despite similar vessel volumes (347.5+/-155.6 vs 356.5+/-164.1 mm(3), p=0.84) and stent volumes (175.6+/-74.57 vs 179.7+/-84.24 mm(3), p=1.0), IVUS analysis showed that neointimal hyperplasia volume was significantly greater in PES restenoses than in SES restenoses (40.0+/-44.2 vs 19.3+/-11.4 mm(3), p=0.02) without any significant difference in distribution over the stent length. This leads to a higher percent of volume obstruction (intimal hyperplasia volume divided by stent volume: 18.5+/-13.7% vs 11.8+/-7.7%, p=0.045). Minimal stent area was smaller in SES than in PES (4.3+/-1.2 vs 5.6+/-1.2 mm(2), p=0.06) and stent underexpansion was more frequently observed in SES stents: minimal stent area <4.5 mm(2) (65% in SES vs 27% in PES, p=0.04). Stent edge restenosis occurred in 1/29 SES (3%) vs 3/11 PES (27%) stents, p=0.056.


CONCLUSIONS
The magnitude of neointimal hyperplasia was greater in PES than in SES while stent underexpansion appeared to be more common in SES.
Ohlmann
Patrick
P
Cardiovascular Research Institute/Medstar Research Institute, Washington Hospital Center, Washington DC, United States. patrick.ohlmann@chru-strasbourg.fr
Mintz
Gary S
GS
Kim
Sang-Wook
SW
Pichard
Augusto D
AD
Satler
Lowel F
LF
Kent
Kenneth M
KM
Suddath
William O
WO
Waksman
Ron
R
Weissman
Neil J
NJ
D002317:Cardiovascular Agents / Q000627:therapeutic use*; D023903:Coronary Restenosis / Q000000981:diagnostic imaging* / Q000517:prevention & control; D054855:Drug-Eluting Stents; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D017239:Paclitaxel / Q000627:therapeutic use*; D012189:Retrospective Studies; D012307:Risk Factors; D020123:Sirolimus / Q000627:therapeutic use*; D016896:Treatment Outcome; D018084:Ultrasonography, Interventional
D002317:Cardiovascular Agents; D017239:Paclitaxel; D020123:Sirolimus