Serial assessment of coronary artery response to paclitaxel-eluting stents using optical coherence tomography.
BACKGROUND
The paucity of longitudinal, serial high-resolution imaging studies has limited our understanding of in vivo arterial response to drug-eluting stents. We sought to investigate the human coronary response to paclitaxel-eluting stent implantation, using serial optical coherence tomography assessments.


RESULTS
Thirty patients with at least 2 significant coronary lesions in different vessels were treated with a paclitaxel-eluting stent. The most severe stenosis (lesion A) was treated at the initial procedure, and the second target vessel (lesion B) was stented 3 months later. Optical coherence tomography was performed at baseline, 3-, and 9-month follow-up for lesions A and baseline and 6 months for lesions B. Prespecified end points were percent of uncovered and malapposed struts over time. In lesions A, uncovered struts were 3.77±4.94% and 3.02±4.35% at 3 versus 9 months (P=NS). Malapposed struts were 3.55±5.16% at post-procedure, 1.51±3.52% at 3 months, and 0.60±1.82% at 9 months (P<0.05, at 3 versus 9 months). Strut-level neointimal thickness was 0.19±0.09 mm and 0.20±0.11 mm (P=NS) over time. Newly acquired malapposition was detected in 10.4% and 3.3% of 2.5-mm segments at 3- and 9-month follow-up. In lesions B, uncovered struts were 2.91±5.47% at 6-months. Malapposed struts were 4.94±6.70% post-procedure and 1.01±3.11% at 6 months (P<0.01), with 0.19±0.09-mm neointimal thickness at follow-up.


CONCLUSIONS
Optical coherence tomography imaging suggested the first 3 months to be the period with most biological activity after paclitaxel-eluting stent implantation, when the proliferative reaction mainly occurs and malapposition resolves. A less active, yet continuous, dynamic arterial response, with resolution and development of malapposition, occurs through 9 months post-treatment.
Cardiovascular Department, Ospedali Riuniti, Bergamo, Italy.
Giulio
G
Guagliumi
Hiram G
HG
Bezerra
Vasile
V
Sirbu
Hideyuki
H
Ikejima
Giuseppe
G
Musumeci
Giuseppe
G
Biondi-Zoccai
Nikoloz
N
Lortkipanidze
Luigi
L
Fiocca
Davide
D
Capodanno
Wei
W
Wang
Satoko
S
Tahara
Angelina
A
Vassileva
Aleksandre
A
Matiashvili
Orazio
O
Valsecchi
Marco A
MA
Costa
D000368:Aged; D019917:Blood Vessel Prosthesis Implantation; D017023:Coronary Angiography; D023921:Coronary Stenosis / Q000188:drug therapy* / Q000473:pathology*; D003331:Coronary Vessels / Q000473:pathology*; D054855:Drug-Eluting Stents; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D017239:Paclitaxel / Q000008:administration & dosage*; D013997:Time Factors; D041623:Tomography, Optical Coherence; D016896:Treatment Outcome
D017239:Paclitaxel