title: Angiographic, optical coherence tomography and histology findings from combination of a drug-coated balloon with an everolimus-eluting stent in a porcine model.
abstract: BACKGROUND
  We designed a porcine model to compare the angiographic, optical coherence tomography (OCT) and histological findings of implanting an everolimus-eluting stent (EES) in the same segment of the coronary artery pre-treated with a drug-coating balloon (DCB; paccocath as carrier) with EES alone and DCB plus a bare metal stent (BMS).
  
  
  METHODS
  Seven female swine averaging 46.0±2.4kg were treated by random assignment as follows: DCB followed by EES; DCB followed by BMS; and EES alone. Quantitative coronary angiography (QCA) and OCT were carried out post-implantation and repeated after 28±1days.
  
  
  RESULTS
  All arteries remained patent and demonstrated no sign of thrombus formation. There was no significant difference at 1month between the treatment groups in lumen loss (0.64±0.43, 0.44±0.43 and 0.33±0.28mm for EES, DCB/EES and DCB/BMS respectively, p=0.37) and binary restenosis (6.86 (2.91-9.12), 4.93 (-1.53-10.7) and 4.18 (3.27-10.2)% respectively, p=0.87). OCT found mean neointimal thickness of 0.15±0.09, 0.07±0.03 and 0.08±0.03mm (p=0.05) for EES, DCB/EES and DCB/BMS respectively. Endothelial strut coverage was 92.3±5.5, 85.4±8.6 and 89.1±8.9% (p=0.05) and mean neointimal area was 1.06±0.42, 0.95±0.24 and 1.20±0.28mm2(p=0.09) respectively. Inflammation score was similar between the three groups: 0.20 (0.20-0.28), 0.30 (0.22-0.48), 0.30 (0.20-0.38) for EES, DCB/EES and DCB/BMS respectively (p=0.14) and there were no differences in fibrin deposition.
  
  
  CONCLUSIONS
  The combination of DCB with EES appeared to be safe and effective. Using EES to bail out suboptimal DCB therapy appeared to be safe and effective in this porcine model.
authors: Tan Tock Seng Hospital Pte Ltd, 11 Jalan Tan Tock Seng, 308433, Singapore. Electronic address: paul_jl_ong@ttsh.com.sg.
authors: Paul J L
authors: PJL
authors: Ong
authors: Wakayama Medical University, Kimiidera 811-1, Wakayama 641-8509, Japan.
authors: Takashi
authors: T
authors: Kubo
authors: Tan Tock Seng Hospital Pte Ltd, 11 Jalan Tan Tock Seng, 308433, Singapore.
authors: Timothy J
authors: TJ
authors: Watson
authors: BBraun Singapore, 600 North Bridge Rd, 188778, Singapore.
authors: Agnes S P
authors: ASP
authors: Seah
authors: Innoheart, 2 Boon Leat Terrace, 119844, Singapore.
authors: Philip E H
authors: PEH
authors: Wong
authors: Wakayama Medical University, Kimiidera 811-1, Wakayama 641-8509, Japan.
authors: Takashi
authors: T
authors: Akasaka
mesh_terms: D015906:Angioplasty, Balloon, Coronary / Q000379:methods*; D000818:Animals; D017023:Coronary Angiography / Q000379:methods*; D023921:Coronary Stenosis / Q000175:diagnosis / Q000601:surgery*; D003331:Coronary Vessels / Q000000981:diagnostic imaging* / Q000601:surgery; D004195:Disease Models, Animal; D054855:Drug-Eluting Stents; D000068338:Everolimus / Q000494:pharmacology*; D005260:Female; D013552:Swine; D041623:Tomography, Optical Coherence / Q000379:methods*
chemical_list: D000068338:Everolimus
keywords: Drug coated balloon; Drug-eluting stent; Everolimus; Porcine coronary artery