Intra-stent tissue evaluation within bare metal and drug-eluting stents > 3 years since implantation in patients with mild to moderate neointimal proliferation using optical coherence tomography and virtual histology intravascular ultrasound.
OBJECTIVE
We aimed to compare neointimal tissue characteristics between bare-metal stents (BMS) and drug-eluting stents (DES) at long-term follow-up using optical coherence tomography (OCT) and virtual histology intravascular ultrasound (VH-IVUS).


BACKGROUND
Neoatherosclerosis in neointima has been reported in BMS and in DES.


METHODS
Thirty patients with 36 stented lesions [BMS (n=17) or DES (n=19)] >3years after implantation were prospectively enrolled. OCT and VH-IVUS were performed and analyzed independently. Stents with ≥70% diameter stenosis were excluded.


RESULTS
The median duration from implantation was 126.0months in the BMS group and 60.0months in the DES group (p <0.001). Lipid-laden intima (58.8% vs. 42.1%, p=0.317), thrombus (17.6% vs. 5.3%, p=0.326), and calcification (35.3% vs. 26.3%, p=0.559) did not show significant differences between BMS and DES. When divided into 3 time periods, the cumulative incidence of lipid-laden neointima from >3years to <9years was similar between BMS and DES (42.9% vs. 42.1%, p=1.000). Furthermore, it continued to gradually increase over time in both groups. OCT-derived thin-cap fibroatheroma (TCFA) was observed in 17.6% of BMS- and 5.3% of DES-treated lesions (p=0.326). No stents had evidence of intimal disruption. The percentage volume of necrotic core (16.1% [9.7, 20.3] vs. 9.7% [7.0, 16.5], p=0.062) and dense calcium (9.5% [3.8, 13.6] vs. 2.7% [0.4, 4.9], p=0.080) in neointima tended to be greater in BMS-treated lesions. Intra-stent VH-TCFA (BMS vs. DES 45.5% vs. 18.2%, p=0.361) did not differ significantly.


CONCLUSIONS
At long-term follow-up beyond 3 years after implantation, the intra-stent neointimal tissue characteristics appeared similar for both BMS and DES.
Division of Cardiology, MedStar Washington Hospital Center, Washington, DC.
Hironori
H
Kitabata
Division of Cardiology, MedStar Washington Hospital Center, Washington, DC.
Joshua P
JP
Loh
Division of Cardiology, MedStar Washington Hospital Center, Washington, DC.
Lakshmana K
LK
Pendyala
Division of Cardiology, MedStar Washington Hospital Center, Washington, DC.
Alfazir
A
Omar
Division of Cardiology, MedStar Washington Hospital Center, Washington, DC.
Hideaki
H
Ota
Division of Cardiology, MedStar Washington Hospital Center, Washington, DC.
Sa'ar
S
Minha
Division of Cardiology, MedStar Washington Hospital Center, Washington, DC.
Marco A
MA
Magalhaes
Division of Cardiology, MedStar Washington Hospital Center, Washington, DC.
Rebecca
R
Torguson
Division of Cardiology, MedStar Washington Hospital Center, Washington, DC.
Fang
F
Chen
Division of Cardiology, MedStar Washington Hospital Center, Washington, DC.
Lowell F
LF
Satler
Division of Cardiology, MedStar Washington Hospital Center, Washington, DC.
Augusto D
AD
Pichard
Division of Cardiology, MedStar Washington Hospital Center, Washington, DC. Electronic address: ron.waksman@medstar.net.
Ron
R
Waksman
D000368:Aged; D049109:Cell Proliferation; D003324:Coronary Artery Disease / Q000000981:diagnostic imaging / Q000473:pathology / Q000628:therapy*; D003331:Coronary Vessels / Q000000981:diagnostic imaging* / Q000473:pathology*; D054855:Drug-Eluting Stents; D005260:Female; D006801:Humans; D008297:Male; D008670:Metals; D008875:Middle Aged; D058426:Neointima; D062645:Percutaneous Coronary Intervention / Q000009:adverse effects / Q000295:instrumentation*; D011237:Predictive Value of Tests; D011446:Prospective Studies; D011474:Prosthesis Design; D012720:Severity of Illness Index; D015607:Stents; D013997:Time Factors; D041623:Tomography, Optical Coherence; D016896:Treatment Outcome; D018084:Ultrasonography, Interventional
D008670:Metals
Neoatherosclerosis; Optical coherence tomography; Stent; Virtual histology intravascular ultrasound