title: Morphological and quantitative analysis of vascular wall and neointimal hyperplasia after coronary stenting: comparison of bare-metal and sirolimus-eluting stents using optical coherence tomography.
abstract: BACKGROUND
  It has been suggested that sirolimus-eluting stents (SES) provoke a more sustained inflammatory response (IR) in neointimal hyperplasia (NIH). The purpose of this study was to compare morphological vessel characteristics, including post-stent IR in NIH, between patients with SES and bare metal stents (BMS) using optical coherence tomography (OCT).
  
  
  RESULTS
  Thirty-seven patients underwent OCT at their post-stent follow-up. OCT signal-intensity deviation (normalized standard-deviation; OCT-NSD) values in NIH were compared between the 2 groups. In addition, the serum concentration of high-sensitivity C-reactive protein (hs-CRP) was measured. Stent-malapposition rate (1.78% vs. 0.7%; P = 0.016), uncovered stent-strut rate (16% vs. 3.7%; P = 0.0002), peri-stent ulcer like appearance (PSUA; 50% vs. 0%; P = 0.006) were all significantly higher in the SES group than in the BMS group, respectively. The OCT-NSD value was also significantly higher in the SES group than in the BMS group (0.213 ± 0.005 vs. 0.198 ± 0.005; P < 0.001), as was the hs-CRP level (2.54 ± 1.89 vs. 0.64 ± 0.3 mg/L; P = 0.0006). In addition, a significant positive correlation was found between hs-CRP and OCT-NSD (r = 0.471; P = 0.0025).
  
  
  CONCLUSIONS
  PSUA-morphology was specific in the SES group, and higher levels of OCT-NSD and hs-CRP after SES implantation suggest sustained IR in NIH compared with following BMS implantation. These different characteristics may be some of the background that promotes thrombus formation as a late-stage post-stent complication of SES.
authors.affiliation: Division of Cardiology, Department of Internal Medicine and Memorial Heart Center, Iwate Medical University, Japan.
authors.forename: Iwao
authors.initials: I
authors.lastname: Goto
authors.forename: Tomonori
authors.initials: T
authors.lastname: Itoh
authors.forename: Takumi
authors.initials: T
authors.lastname: Kimura
authors.forename: Tetsuya
authors.initials: T
authors.lastname: Fusazaki
authors.forename: Hiroki
authors.initials: H
authors.lastname: Matsui
authors.forename: Shoma
authors.initials: S
authors.lastname: Sugawara
authors.forename: Kentaro
authors.initials: K
authors.lastname: Komuro
authors.forename: Motoyuki
authors.initials: M
authors.lastname: Nakamura
mesh_terms: D000368:Aged; D015906:Angioplasty, Balloon, Coronary; D015415:Biomarkers / Q000097:blood; D002097:C-Reactive Protein / Q000378:metabolism; D017023:Coronary Angiography; D003324:Coronary Artery Disease / Q000473:pathology / Q000628:therapy; D003331:Coronary Vessels / Q000000981:diagnostic imaging / Q000473:pathology*; D054855:Drug-Eluting Stents / Q000009:adverse effects*; D005260:Female; D006801:Humans; D006965:Hyperplasia / Q000097:blood / Q000209:etiology / Q000473:pathology; D007249:Inflammation / Q000097:blood / Q000209:etiology / Q000473:pathology; D008297:Male; D008670:Metals; D008875:Middle Aged; D058426:Neointima / Q000000981:diagnostic imaging / Q000473:pathology*; D020123:Sirolimus; D015607:Stents / Q000009:adverse effects*; D041623:Tomography, Optical Coherence; D018084:Ultrasonography, Interventional
chemical_list: D015415:Biomarkers; D008670:Metals; D002097:C-Reactive Protein; D020123:Sirolimus