Optical coherence tomography (OCT) strut-level analysis of drug-eluting stents (DES) in human coronary bifurcations.
We sought to evaluate the vascular response of stent struts deployed in bifurcation segments using optical coherence tomography (OCT).



This study is a sub-analysis of ODESSA, a prospective randomised trial designed to evaluate healing of overlapped drug-eluting stents (DES) vs. bare metal stents (BMS) (sirolimus SES: paclitaxel PES: zotarolimus ZES: Liberté BMS in a 2: 2: 2: 1 ratio) for de novo coronary artery stenosis. OCT was performed at 6-month follow-up. Bifurcation segments with side branch diameters larger than 1.5mm by angiography were analysed. The cross-sectional image at the bifurcation segment was divided into three regions: opposite to the ostium (OO), adjacent to the ostium (AO), or side-branch ostium (SO). Struts were classified in three categories: uncovered (U), covered (C), or proliferative (P). The incidence of each strut category was compared between regions and stent types. There were 12,656 struts in 61 bifurcation segments (PES: 16, SES: 14, ZES: 23, Liberté BMS: 8) from 46 patients obtained at six months. PES had the highest rate of U in SO region (PES 60.1, SES 17.0, ZES 13.2, BMS 12.3 (%), P<0.0001), whereas SES demonstrated the highest rate of U in OO (PES 3.8, SES 14.0, ZES 1.5, BMS 0.0 (%), P=0.0025).



This study demonstrates a variable pattern of strut coverage in the bifurcation among stent technologies, with a high percentage of PES floating struts remaining uncovered at 6-month follow-up.
Kyono
Hiroyuki
H
Harrington-McLaughlin Heart & Vascular Institute, Cardiovascular Imaging Core Laboratory, University Hospitals Medical Center, Case Western Reserve University School of Medicine, Cleveland, OH, USA.
Guagliumi
Giulio
G
Sirbu
Vasile
V
Rosenthal
Noah
N
Tahara
Satoko
S
Musumeci
Giuseppe
G
Trivisonno
Antonio
A
Bezerra
Hiram G
HG
Costa
Marco A
MA
D000368:Aged; D000369:Aged, 80 and over; D015906:Angioplasty, Balloon, Coronary / Q000295:instrumentation*; D017023:Coronary Angiography; D003324:Coronary Artery Disease / Q000000981:diagnostic imaging / Q000628:therapy*; D003331:Coronary Vessels / Q000473:pathology*; D054855:Drug-Eluting Stents; D005260:Female; D006801:Humans; D008297:Male; D008670:Metals; D008875:Middle Aged; D011446:Prospective Studies; D011474:Prosthesis Design; D015607:Stents; D013997:Time Factors; D041623:Tomography, Optical Coherence; D016896:Treatment Outcome
D008670:Metals