Heterogeneous arterial healing in patients following paclitaxel-eluting stent implantation: comparison with sirolimus-eluting stents.
OBJECTIVE
We angioscopically compared paclitaxel-eluting stents (PES) and sirolimus-eluting stents (SES) to explore differences in arterial healing.


BACKGROUND
Drug-eluting stents may demonstrate different arterial healing processes.


METHODS
Angioscopy was performed 9 +/- 2 months after 30 PES and 36 SES were implanted initially in the native coronary artery. Heterogeneity of the neointimal coverage (NIC) as well as the dominant grade was examined. Neointimal coverage was defined as follows: grade 0 = fully visible struts; grade 1 = struts bulged into the lumen, but covered; grade 2 = embedded, but translucent struts; grade 3 = invisible struts. Heterogeneity was judged when the NIC grade variation >or=1. Thrombi and yellow plaques (YP) were also explored.


RESULTS
In-stent late loss (0.44 +/- 0.44 mm vs. 0.13 +/- 0.33 mm; p < 0.0001) and dominant NIC grade (1.8 +/- 1.1 vs. 1.3 +/- 0.7; p = 0.02) were greater in PES than in SES. Of PES, 48% showed the heterogeneity of 1 grade; 26% showed that of 2 grades. Of SES, 53% showed homogeneous coverage; the remaining SES showed the heterogeneity of 1 grade; and 72% showed dominant grade 1. Thrombi were more common in PES than in SES (43% vs. 19%; p = 0.04). Both stents commonly revealed YP (83% vs. 78%; p = 0.76).


CONCLUSIONS
NIC was more heterogeneous in PES, associated with a higher incidence of thrombi. Homogeneous NIC may be an important factor for competent arterial healing.
Awata
Masaki
M
Cardiovascular Division, Kansai Rosai Hospital, Amagasaki, Japan.
Nanto
Shinsuke
S
Uematsu
Masaaki
M
Morozumi
Takakazu
T
Watanabe
Tetsuya
T
Onishi
Toshinari
T
Iida
Osamu
O
Sera
Fusako
F
Minamiguchi
Hitoshi
H
Kotani
Jun-ichi
J
Nagata
Seiki
S
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000972:Antineoplastic Agents, Phytogenic / Q000627:therapeutic use*; D001241:Aspirin / Q000627:therapeutic use; D017023:Coronary Angiography; D003324:Coronary Artery Disease / Q000188:drug therapy* / Q000473:pathology; D023903:Coronary Restenosis; D003331:Coronary Vessels / Q000187:drug effects* / Q000473:pathology; D054855:Drug-Eluting Stents; D004730:Endothelium, Vascular / Q000187:drug effects* / Q000473:pathology; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D017239:Paclitaxel / Q000627:therapeutic use*; D010975:Platelet Aggregation Inhibitors / Q000627:therapeutic use; D012189:Retrospective Studies; D013988:Ticlopidine / Q000627:therapeutic use
D000972:Antineoplastic Agents, Phytogenic; D010975:Platelet Aggregation Inhibitors; D013988:Ticlopidine; D017239:Paclitaxel; D001241:Aspirin