Lack of association between large angiographic late loss and low risk of in-stent thrombus: angioscopic comparison between paclitaxel- and sirolimus-eluting stents.
BACKGROUND
It recently has been hypothesized that a larger late loss may have a protective role against stent thrombosis. The relationship between angiographic late loss and the presence of thrombus based on angioscopic findings within paclitaxel-eluting stents (PES) and sirolimus-eluting stents (SES) was investigated in this study.


RESULTS
Prospective 6-month follow-up angiographic and angioscopic examinations were performed on 18 patients for PES and on 20 patients for SES. Late loss was measured by quantitative coronary angiography. Angioscopic neointimal stent coverage (NSC) grade was classified as follows: 0=uncovered struts without neointima, 1=visible struts through thin neointima, and 2=no visible struts. In each patient, maximum NSC, minimum NSC, and the existence of thrombus were evaluated. Late loss and maximum NSC were greater in PES than in SES (0.38+/-0.43 versus 0.10+/-0.23 mm; P=0.02 and P=0.0004, respectively). Late loss was correlated with maximum NSC (grade 0, 0.06+/-0.01 mm; grade 1, 0.10+/-0.05 mm; and grade 2, 0.48+/-0.46 mm), whereas there was no correlation between late loss and minimum NSC. The prevalence of patients with uncovered struts did not differ (44% of PES, 40% of SES; P=0.78). In-stent thrombus was found more frequently in PES than in SES (72% versus 40%, P=0.046) despite no occurrence of stent thrombosis. Only within PES were thrombi found in the segments of NSC grade 2 associated with large late loss.


CONCLUSIONS
The present study suggests that angiographic large late loss was not associated with a low risk of in-stent thrombus.
Takano
Masamichi
M
Nippon Medical School, Tokyo, Japan. takanom@nms.ac.jp
Yamamoto
Masanori
M
Murakami
Daisuke
D
Inami
Shigenobu
S
Okamatsu
Kentaro
K
Seimiya
Koji
K
Ohba
Takayoshi
T
Seino
Yoshihiko
Y
Mizuno
Kyoichi
K
D000368:Aged; D017546:Angioscopy; D019917:Blood Vessel Prosthesis Implantation / Q000009:adverse effects*; D017023:Coronary Angiography; D003328:Coronary Thrombosis / Q000000981:diagnostic imaging / Q000188:drug therapy / Q000209:etiology*; D003331:Coronary Vessels / Q000473:pathology; D054855:Drug-Eluting Stents; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D006965:Hyperplasia / Q000000981:diagnostic imaging / Q000188:drug therapy / Q000209:etiology*; D008297:Male; D008875:Middle Aged; D017239:Paclitaxel / Q000627:therapeutic use*; D020123:Sirolimus / Q000627:therapeutic use*
D017239:Paclitaxel; D020123:Sirolimus