title: Optical coherence tomography assessment of in vivo vascular response after implantation of overlapping bare-metal and drug-eluting stents.
abstract: OBJECTIVE
  We designed a randomized trial exploiting optical coherence tomography (OCT) to assess coverage and apposition of overlapping bare-metal stents (BMS) and drug-eluting stents (DES) in human coronary arteries.
  
  
  BACKGROUND
  Overlapping DES impair healing in animals. Optical coherence tomography allows accurate in vivo assessment of stent strut coverage and apposition.
  
  
  METHODS
  Seventy-seven patients with long coronary stenoses were randomized to overlapping sirolimus-eluting stents (SES), paclitaxel-eluting stents (PES), zotarolimus-eluting stents (ZES), or BMS. The primary goal of the study was to determine the rate of uncovered/malapposed struts in overlap versus nonoverlap segments, according to stent type, at 6-month follow-up with OCT.
  
  
  RESULTS
  A total of 53,047 struts were analyzed. The rate of uncovered/malapposed struts was 1.5 +/- 3.4% and 0.6 +/- 2.7% in overlap versus nonoverlap BMS (p = NS), respectively, and 4.3 +/- 11% and 3.6 +/- 8% in overlap versus nonoverlap DES (p = NS), respectively. There were no differences in the rates of uncovered/malapposed struts between overlapping BMS and DES, likely due to low frequency of uncovered/malapposed struts in ZES (0.1 +/- 0.4%), which offset the higher rates observed in SES (6.7 +/- 9.6%) and PES (6.7 +/- 16.5%, p < 0.05). Overlap segments showed greater neointimal volume obstruction versus nonoverlap segments in all DES (p < 0.05 for all DES types). Strut-level neointimal thickness at overlap and nonoverlap segments were lowest in SES (0.16 +/- 0.1 mm and 0.12 +/- 0.1 mm, respectively) compared with PES (0.27 +/- 0.1 mm and 0.20 +/- 0.1 mm, respectively), ZES (0.40 +/- 0.16 mm and 0.33 +/- 0.13 mm, respectively), and BMS (0.55 +/- 0.31 mm and 0.53 +/- 0.25 mm, respectively, p < 0.05).
  
  
  CONCLUSIONS
  As assessed by OCT the impact of DES on vascular healing was similar at overlapping and nonoverlapping sites. However, strut malapposition, coverage pattern, and neointimal hyperplasia differ significantly according to DES type. (Optical Coherence Tomography for Drug Eluting Stent Safety [ODESSA]; NCT00693030).
authors.affiliation: Division of Cardiology, Cardiovascular Department, Ospedali Riuniti di Bergamo, Bergamo, Italy. guagliumig@gmail.com
authors.forename: Giulio
authors.initials: G
authors.lastname: Guagliumi
authors.forename: Giuseppe
authors.initials: G
authors.lastname: Musumeci
authors.forename: Vasile
authors.initials: V
authors.lastname: Sirbu
authors.forename: Hiram G
authors.initials: HG
authors.lastname: Bezerra
authors.forename: Nobuaki
authors.initials: N
authors.lastname: Suzuki
authors.forename: Luigi
authors.initials: L
authors.lastname: Fiocca
authors.forename: Aleksandre
authors.initials: A
authors.lastname: Matiashvili
authors.forename: Nikoloz
authors.initials: N
authors.lastname: Lortkipanidze
authors.forename: Antonio
authors.initials: A
authors.lastname: Trivisonno
authors.forename: Orazio
authors.initials: O
authors.lastname: Valsecchi
authors.forename: Giuseppe
authors.initials: G
authors.lastname: Biondi-Zoccai
authors.forename: Marco A
authors.initials: MA
authors.lastname: Costa
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D015906:Angioplasty, Balloon, Coronary / Q000009:adverse effects / Q000295:instrumentation*; D002317:Cardiovascular Agents / Q000008:administration & dosage*; D017023:Coronary Angiography; D023921:Coronary Stenosis / Q000473:pathology / Q000628:therapy*; D003331:Coronary Vessels / Q000473:pathology*; D054855:Drug-Eluting Stents; D005240:Feasibility Studies; D005260:Female; D006801:Humans; D006965:Hyperplasia; D008297:Male; D008670:Metals; D008875:Middle Aged; D017239:Paclitaxel / Q000008:administration & dosage; D011237:Predictive Value of Tests; D011446:Prospective Studies; D011474:Prosthesis Design; D020123:Sirolimus / Q000008:administration & dosage / Q000031:analogs & derivatives; D015607:Stents; D013997:Time Factors; D041623:Tomography, Optical Coherence; D016896:Treatment Outcome; D018084:Ultrasonography, Interventional
chemical_list: D002317:Cardiovascular Agents; D008670:Metals; C489443:zotarolimus; D017239:Paclitaxel; D020123:Sirolimus