title: Long-term vascular healing in response to sirolimus- and paclitaxel-eluting stents: an optical coherence tomography study.
abstract: OBJECTIVE
  This study sought to assess stent strut coverage, malapposition, protrusion, and coronary evaginations as markers of healing 5 years after implantation of sirolimus-eluting stents (SES) and paclitaxel-eluting stents (PES), by optical coherence tomography (OCT).
  
  
  BACKGROUND
  Early-generation drug-eluting stents have been shown to delay vascular healing.
  
  
  METHODS
  A total of 88 event-free patients with 1 randomly selected lesion were suitable for final OCT analysis 5 years after drug-eluting stent implantation. The analytical approach was based on a hierarchical Bayesian random-effects model.
  
  
  RESULTS
  OCT analysis was performed at 5 years in 41 SES lesions with 6,380 struts, and in 47 PES lesions with 6,782 struts. A total of 196 struts were uncovered in SES (1.5%) compared with 185 struts in PES lesions (1.0%, 95% credibility interval [CrI]: 0.5 to 1.6; p = 0.32). Malapposed struts were present in 1.2% of SES compared with 0.7% of PES struts (0.7%, 95% CrI: 0.03 to 1.6; p = 0.23). Protruding struts were more frequent among SES (n = 114; 0.8%) than PES lesions (n = 24; 0.1%, 95% CrI: 0.3 to 1.3; p < 0.01). Coronary evaginations were more common among SES- than PES-treated lesions (17 vs. 7 per 100 cross sections, p = 0.003). During extended clinical follow-up, 2 patients suffered from very late stent thrombosis showing a high degree of malapposition, protrusion, and coronary evaginations at the time of OCT investigation.
  
  
  CONCLUSIONS
  Early-generation drug-eluting stents show a similar degree of strut coverage and malapposition at 5 years of follow-up. Despite an overall low degree of uncovered and malapposed struts in event-free patients, some lesions show a clustering of these characteristics, indicating a heterogeneous healing response, which may be the source for very late adverse events.
authors.affiliation: Department of Cardiology, Bern University Hospital, Bern, Switzerland.
authors.forename: Lorenz
authors.initials: L
authors.lastname: Räber
authors.forename: Sandro
authors.initials: S
authors.lastname: Baumgartner
authors.forename: Hector M
authors.initials: HM
authors.lastname: Garcia-Garcia
authors.forename: Hector M Garcia
authors.initials: HM
authors.lastname: Garcia
authors.forename: Bindu
authors.initials: B
authors.lastname: Kalesan
authors.forename: Jörn
authors.initials: J
authors.lastname: Justiz
authors.forename: Thomas
authors.initials: T
authors.lastname: Pilgrim
authors.forename: Aris
authors.initials: A
authors.lastname: Moschovitis
authors.forename: Ahmed A
authors.initials: AA
authors.lastname: Khattab
authors.forename: Lutz
authors.initials: L
authors.lastname: Buellesfeld
authors.forename: Peter
authors.initials: P
authors.lastname: Wenaweser
authors.forename: Bernhard
authors.initials: B
authors.lastname: Meier
authors.forename: Patrick W
authors.initials: PW
authors.lastname: Serruys
authors.forename: Peter
authors.initials: P
authors.lastname: Jüni
authors.forename: Stephan
authors.initials: S
authors.lastname: Windecker
mesh_terms: D015906:Angioplasty, Balloon, Coronary / Q000009:adverse effects / Q000295:instrumentation*; D001499:Bayes Theorem; D002317:Cardiovascular Agents / Q000008:administration & dosage*; D017023:Coronary Angiography; D003324:Coronary Artery Disease / Q000000981:diagnostic imaging / Q000473:pathology / Q000628:therapy*; D003328:Coronary Thrombosis / Q000209:etiology / Q000473:pathology; D003331:Coronary Vessels / Q000473:pathology*; D054855:Drug-Eluting Stents; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D058426:Neointima; D017239:Paclitaxel / Q000008:administration & dosage*; D011237:Predictive Value of Tests; D011474:Prosthesis Design; D020123:Sirolimus / Q000008:administration & dosage*; D013997:Time Factors; D041623:Tomography, Optical Coherence; D016896:Treatment Outcome; D014945:Wound Healing
chemical_list: D002317:Cardiovascular Agents; D017239:Paclitaxel; D020123:Sirolimus