title: Angiographic, IVUS and OCT evaluation of the long-term impact of coronary disease severity at the site of overlapping drug-eluting and bare metal stents: a substudy of the ODESSA trial.
abstract: BACKGROUND
  A potentially adverse vascular response to overlapping drug eluting stents (DES) has been suggested in current research.
  
  
  OBJECTIVE
  To evaluate the impact of baseline disease severity at the site of stent overlap.
  
  
  RESULTS
  This is a substudy of ODESSA, a prospective, randomised controlled trial designed to evaluate healing of overlapping stents. 71/77 patients with a total of 86 overlapping stents were studied: 25 sirolimus, 24 paclitaxel, 26 zotarolimus-eluting stents; and 11 bare metal stents (BMS). Patients were categorised into high-grade stenosis (HGS, ≥ 70% diameter stenosis) and low-grade stenosis (LGS, <70%) at the site of stent overlap. Angiography and intravascular ultrasound were performed after stent deployment and repeated at 6 months, together with additional optical coherence tomography. Images were analysed by an independent core laboratory. End points were binary restenosis, percentage neointimal hyperplasia (%NIH), mean lumen and stent areas and degree of strut coverage/apposition at overlapping stents at 6 months. Stent overlaps occurred in 49 HGS and 37 LGS. Restenosis was found in 5/6 HGS versus 0/5 LGS treated with overlapping BMS (p=0.01) and 4/43 HGS versus 0/32 LGS treated with overlapping DES. There was a trend towards higher %NIH at BMS overlap in HGS versus LGS (p=0.07). DES overlaps had lower lumen and stent areas and similar %NIH in HGS versus LGS. Any uncovered or malapposed struts occurred more often in overlapping DES at LGS than at HGS (59.4% vs 32.6%, p=0.03).
  
  
  CONCLUSIONS
  Overlapping DES in normal-appearing coronary segments showed a higher incidence of uncovered or malapposed struts, while restenosis occurred exclusively in overlapping stents at HGS. These findings should be considered when deploying overlapping stents.
authors.affiliation: Harrington McLaughlin Heart and Vascular Institute, University Hospitals Case Medical Centre, Cleveland, OH 44106-5038, USA.
authors.forename: Satoko
authors.initials: S
authors.lastname: Tahara
authors.forename: Hiram G
authors.initials: HG
authors.lastname: Bezerra
authors.forename: Vasile
authors.initials: V
authors.lastname: Sirbu
authors.forename: Hiroyuki
authors.initials: H
authors.lastname: Kyono
authors.forename: Giuseppe
authors.initials: G
authors.lastname: Musumeci
authors.forename: Noah
authors.initials: N
authors.lastname: Rosenthal
authors.forename: Giulio
authors.initials: G
authors.lastname: Guagliumi
authors.forename: Marco A
authors.initials: MA
authors.lastname: Costa
mesh_terms: D000368:Aged; D003327:Coronary Disease / Q000000981:diagnostic imaging / Q000628:therapy*; D054855:Drug-Eluting Stents; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D017239:Paclitaxel / Q000008:administration & dosage; D011446:Prospective Studies; D011859:Radiography; D020123:Sirolimus / Q000008:administration & dosage / Q000031:analogs & derivatives; D015607:Stents; D041623:Tomography, Optical Coherence; D016896:Treatment Outcome; D050257:Tubulin Modulators / Q000008:administration & dosage*; D018084:Ultrasonography, Interventional
chemical_list: D050257:Tubulin Modulators; C489443:zotarolimus; D017239:Paclitaxel; D020123:Sirolimus