title: Vascular responses in patients with and without diabetes mellitus after everolimus-eluting stent implantation.
abstract: BACKGROUND
  Previous reports have shown potential disadvantages of limus-derivative drugs for the stenting treatment of patients with diabetes mellitus (DM). METHODS AND RESULTS: We studied 159 coronary artery lesions (DM: n=72, non-DM: n=87) in 123 patients treated with everolimus-eluting stent (EES) and who underwent scheduled 9-month follow-up angiography with optical coherence tomography (OCT) regardless of symptoms. In addition to standard OCT variables, neointimal unevenness score (maximum/average neointimal thickness) and stent eccentricity index (minimum/maximum stent diameter) were calculated for each cross-section. To investigate a potential baseline difference between DM and non-DM lesions, pre- and post-interventional intravascular ultrasound (IVUS) images were also evaluated as an IVUS subgroup analysis. The average neointimal thickness and neointimal coverage did not differ between DM and non-DM patients. DM patients had, however, greater asymmetric stent expansion and variability of neointimal thickness than non-DM patients. There was a weak, but significant association between average stent eccentricity index and neointimal unevenness score. The IVUS substudy showed that the culprit plaque volume and plaque eccentricity in DM patients were significantly greater than in non-DM patients.
  
  
  CONCLUSIONS
  Although EES provided a similar level of average neointimal thickness and coverage both in the presence and absence of DM, uneven neointimal suppression occurred in DM patients. A larger plaque volume of the culprit lesion may hamper symmetric stent expansion, possibly explaining the non-uniform neointimal suppression in DM patients.
authors.affiliation: Division of Cardiovascular and Respiratory Medicine, Department of Internal Medicine, Kobe University Graduate School of Medicine.
authors.forename: Masamichi
authors.initials: M
authors.lastname: Iwasaki
authors.forename: Hiromasa
authors.initials: H
authors.lastname: Otake
authors.forename: Toshiro
authors.initials: T
authors.lastname: Shinke
authors.forename: Masayuki
authors.initials: M
authors.lastname: Nakagawa
authors.forename: Hirotoshi
authors.initials: H
authors.lastname: Hariki
authors.forename: Tsuyoshi
authors.initials: T
authors.lastname: Osue
authors.forename: Takumi
authors.initials: T
authors.lastname: Inoue
authors.forename: Yu
authors.initials: Y
authors.lastname: Taniguchi
authors.forename: Ryo
authors.initials: R
authors.lastname: Nishio
authors.forename: Hiroto
authors.initials: H
authors.lastname: Kinutani
authors.forename: Akihide
authors.initials: A
authors.lastname: Konishi
authors.forename: Noritoshi
authors.initials: N
authors.lastname: Hiranuma
authors.forename: Masaru
authors.initials: M
authors.lastname: Kuroda
authors.forename: Junya
authors.initials: J
authors.lastname: Shite
authors.forename: Ken-ichi
authors.initials: K
authors.lastname: Hirata
mesh_terms: D000368:Aged; D003324:Coronary Artery Disease / Q000473:pathology / Q000601:surgery*; D003920:Diabetes Mellitus; D054855:Drug-Eluting Stents; D000068338:Everolimus; D005260:Female; D005500:Follow-Up Studies; D006083:Graft Occlusion, Vascular / Q000209:etiology / Q000473:pathology*; D006801:Humans; D007166:Immunosuppressive Agents; D008297:Male; D008875:Middle Aged; D058426:Neointima / Q000209:etiology / Q000473:pathology*; D020123:Sirolimus / Q000031:analogs & derivatives*; D041623:Tomography, Optical Coherence
chemical_list: D007166:Immunosuppressive Agents; D000068338:Everolimus; D020123:Sirolimus