Analysis of the long-term effects of drug-eluting stents on coronary arterial wall morphology as assessed by virtual histology intravascular ultrasound.
BACKGROUND
Animal models show impairment of arterial healing after drug-eluting stents (DES) compared with bare-metal stents (BMS). Virtual histology intravascular ultrasound (VH-IVUS) offers an opportunity to assess lesion morphology in vivo.


METHODS
We used VH-IVUS in 80 patients to assess long-term (median = 10 months) native artery vascular responses after 76 implantations of DES compared with 32 BMS. The presence of "necrotic core abutting the lumen" was evaluated at baseline and follow-up.


RESULTS
At baseline, necrotic core abutting the lumen through the stent struts was observed in 76% of DES and 75% of BMS. Although the percentage of necrotic core within the plaque behind the stents did not change during follow-up in DES (23% [18%, 28%] to 22% [17%, 27%], P = .57) or BMS (22% [19%, 27%] to 20% [12%, 26%], P = .29), necrotic core abutting the lumen through the stent struts decreased more in BMS (75% to 19%, P < .001) than DES (76% to 61%, P = .036) because of the lack of an overlying, protective neointima in DES-treated lesions. Furthermore, within the adjacent reference segments, the incidence of necrotic core abutting the lumen decreased in BMS-treated lesions (proximal 23% to 0%, P = .023; distal 21% to 0%, P = .023), but not in DES (proximal 22% to 17%, P = .48; distal 23% to 21%, P = .82).


CONCLUSIONS
Serial VH-IVUS analysis of DES-treated lesions showed a greater frequency of unstable lesion morphometry at follow-up compared with BMS. The apparent mechanism was a suppression of the protective neointimal hyperplasia layer coupled with a lack of vulnerable plaque resolution at reference segments in DES compared with BMS.
Kubo
Takashi
T
Cardiovascular Research Foundation, 111 East 59th Street, New York, NY 10022, USA.
Maehara
Akiko
A
Mintz
Gary S
GS
Garcia-Garcia
Hector M
HM
Serruys
Patrick W
PW
Suzuki
Takahiko
T
Klauss
Volker
V
Sumitsuji
Satoru
S
Lerman
Amir
A
Marso
Steven P
SP
Margolis
M Pauliina
MP
Margolis
James R
JR
Foster
Michael C
MC
De Bruyne
Bernard
B
Leon
Martin B
MB
Stone
Gregg W
GW
D003331:Coronary Vessels / Q000000981:diagnostic imaging* / Q000473:pathology*; D054855:Drug-Eluting Stents; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D013997:Time Factors; D018084:Ultrasonography, Interventional