Comparative analysis of neointimal coverage with paclitaxel and zotarolimus drug-eluting stents, using optical coherence tomography 6 months after implantation.
BACKGROUND
Intrastent thrombosis, while rare, has a poor prognosis. Strut non-coverage is one causal factor, especially in cases of resistance to or premature discontinuation of dual antiplatelet therapy.


OBJECTIVE
To compare neointimal coverage with paclitaxel and zotarolimus drug-eluting stents, using optical coherence tomography (OCT).


METHODS
Twenty-two drug-eluting stents (11 paclitaxel-eluting stents and 11 zotarolimus-eluting stents) were examined by OCT, 6 months after implantation. Mean neointimal strut-coverage thickness and percentage neointimal hyperplasia were measured every millimetre. On each OCT image, struts were classified into one of four categories: well-apposed to vessel wall with apparent neointimal coverage; well-apposed to vessel wall without neointimal coverage; malapposed to the vessel wall; or located on a major side branch.


RESULTS
OCT analysis showed a lower percentage of neointimal hyperplasia with paclitaxel-eluting stents than with zotarolimus-eluting stents (17% vs 38% and mean thickness 154 microm vs 333 microm, respectively; p<0.0001). The rate of strut-coverage was greater with zotarolimus-eluting stents than with paclitaxel-eluting stents (99.1% vs 87.1%, respectively; p<0.0001). A non-covered/covered strut ratio greater than 0.3 was observed in 0.5% of zotarolimus-eluting stent OCT images compared with 18% of paclitaxel-eluting stent OCT images (p<0.0001).


CONCLUSIONS
Six months after implantation, neointimal hyperplasia was greater with zotarolimus-eluting stents compared with paclitaxel-eluting stents. Conversely, neointimal strut-coverage was better with zotarolimus-eluting stents.
Department of Cardiology, Clermont-Ferrand Teaching Hospital, Gabriel Montpied Hospital, BP 69, 63000 Clermont-Ferrand, France.
Pascal
P
Motreff
Géraud
G
Souteyrand
Sebastien
S
Levesque
Lemlih
L
Ouchchane
Claire
C
Dauphin
Laurent
L
Sarry
Jean
J
Cassagnes
Jean-René
JR
Lusson
D000328:Adult; D000368:Aged; D017130:Angioplasty / Q000009:adverse effects / Q000295:instrumentation*; D002317:Cardiovascular Agents / Q000008:administration & dosage*; D049109:Cell Proliferation / Q000187:drug effects; D017023:Coronary Angiography; D003324:Coronary Artery Disease / Q000628:therapy*; D023903:Coronary Restenosis / Q000209:etiology / Q000473:pathology / Q000517:prevention & control*; D003328:Coronary Thrombosis / Q000209:etiology / Q000473:pathology / Q000517:prevention & control*; D054855:Drug-Eluting Stents; D005260:Female; D006801:Humans; D006965:Hyperplasia; D008297:Male; D008875:Middle Aged; D017239:Paclitaxel / Q000008:administration & dosage*; D010975:Platelet Aggregation Inhibitors / Q000627:therapeutic use; D011237:Predictive Value of Tests; D020123:Sirolimus / Q000008:administration & dosage / Q000031:analogs & derivatives*; D013997:Time Factors; D041623:Tomography, Optical Coherence; D016896:Treatment Outcome; D017539:Tunica Intima / Q000187:drug effects* / Q000473:pathology
D002317:Cardiovascular Agents; D010975:Platelet Aggregation Inhibitors; C489443:zotarolimus; D017239:Paclitaxel; D020123:Sirolimus