Top

The International Journal of Cardiovascular Imaging

Published in:

01-10-2018 | Original Paper

Differences between first-generation and second-generation drug-eluting stent regarding in-stent neoatherosclerosis characteristics: an optical coherence tomography analysis

Authors: Norihiro Kobayashi, Yoshiaki Ito, Masahiro Yamawaki, Motoharu Araki, Tsuyoshi Sakai, Masaru Obokata, Yasunari Sakamoto, Shinsuke Mori, Masakazu Tsutsumi, Masahiro Nauchi, Yohsuke Honda, Takahiro Tokuda, Kenji Makino, Shigemitsu Shirai, Keisuke Hirano

Published in: The International Journal of Cardiovascular Imaging | Issue 10/2018

Abstract

We compared first-generation and second-generation drug-eluting stent (DES) with respect to neoatherosclerosis using optical coherence tomography or optical frequency domain imaging. In-stent restenoses in 102 first-generation and 114 second-generation DES were retrospectively assessed. Neoatherosclerosis, which was defined as the presence of lipid-laden neointima or calcification inside a stent, was observed in 33 (27.2%) and 31 (32.4%) lesions in the first-generation and second-generation DES respectively. In the first-generation DES group, the lipid length was significantly longer (5.5 ± 3.8 vs. 3.1 ± 2.1 mm, P = 0.0007), the lipid arc was significantly larger (324 ± 70° vs. 250 ± 94°, P = 0.002), the prevalence of a 360° lipid arc was significantly greater (58 vs. 31%, P = 0.03), and the fibrous cap was significantly thinner (153 ± 85 vs. 211 ± 95 µm, P = 0.02) compared with those in the second-generation DES group. These differences remained significant after adjusting for the age of the stent (lipid length: P < 0.001; lipid arc: P = 0.019; and fibrous cap thickness: P < 0.001). The proliferation course and stability of neoatherosclerosis over time might be superior in second-generation DES.

Moses JW, Leon MB, Popma JJ, Fitzgerald PJ, Holmes DR, O’Shaughnessy C, Caputo RP, Kereiakes DJ, Williams DO, Teirstein PS, Jaeger JL, Kuntz RE (2003) Sirolimus-eluting stents versus standard stents in patients with stenosis in a native coronary artery. N Engl J Med 349(14):1315–1323. https://doi.org/10.1056/NEJMoa035071 CrossRefPubMed

Daemen J, Wenaweser P, Tsuchida K, Abrecht L, Vaina S, Morger C, Kukreja N, Juni P, Sianos G, Hellige G, van Domburg RT, Hess OM, Boersma E, Meier B, Windecker S, Serruys PW (2007) Early and late coronary stent thrombosis of sirolimus-eluting and paclitaxel-eluting stents in routine clinical practice: data from a large two-institutional cohort study. Lancet 369(9562):667–678. https://doi.org/10.1016/s0140-6736(07)60314-6 CrossRefPubMed

Wenaweser P, Daemen J, Zwahlen M, van Domburg R, Juni P, Vaina S, Hellige G, Tsuchida K, Morger C, Boersma E, Kukreja N, Meier B, Serruys PW, Windecker S (2008) Incidence and correlates of drug-eluting stent thrombosis in routine clinical practice. 4-year results from a large 2-institutional cohort study. J Am Coll Cardiol 52(14):1134–1140. https://doi.org/10.1016/j.jacc.2008.07.006 CrossRefPubMed

Fujii K, Carlier SG, Mintz GS, Yang YM, Moussa I, Weisz G, Dangas G, Mehran R, Lansky AJ, Kreps EM, Collins M, Stone GW, Moses JW, Leon MB (2005) Stent underexpansion and residual reference segment stenosis are related to stent thrombosis after sirolimus-eluting stent implantation: an intravascular ultrasound study. J Am Coll Cardiol 45(7):995–998. https://doi.org/10.1016/j.jacc.2004.12.066 CrossRefPubMed

Finn AV, Joner M, Nakazawa G, Kolodgie F, Newell J, John MC, Gold HK, Virmani R (2007) Pathological correlates of late drug-eluting stent thrombosis: strut coverage as a marker of endothelialization. Circulation 115(18):2435–2441. https://doi.org/10.1161/CIRCULATIONAHA.107.693739 CrossRefPubMed

Kosonen P, Vikman S, Jensen LO, Lassen JF, Harnek J, Olivecrona GK, Erglis A, Fossum E, Niemela M, Kervinen K, Ylitalo A, Pietila M, Aaroe J, Kellerth T, Saunamaki K, Thayssen P, Hellsten L, Thuesen L, Niemela K (2013) Intravascular ultrasound assessed incomplete stent apposition and stent fracture in stent thrombosis after bare metal versus drug-eluting stent treatment the Nordic Intravascular Ultrasound Study (NIVUS). Int J Cardiol 168(2):1010–1016. https://doi.org/10.1016/j.ijcard.2012.10.033 CrossRefPubMed

Kang SJ, Lee CW, Song H, Ahn JM, Kim WJ, Lee JY, Park DW, Lee SW, Kim YH, Mintz GS, Park SW, Park SJ (2013) OCT analysis in patients with very late stent thrombosis. JACC Cardiovasc Imaging 6(6):695–703. https://doi.org/10.1016/j.jcmg.2013.02.006 CrossRefPubMed

Taniwaki M, Radu MD, Zaugg S, Amabile N, Garcia-Garcia HM, Yamaji K, Jorgensen E, Kelbaek H, Pilgrim T, Caussin C, Zanchin T, Veugeois A, Abildgaard U, Juni P, Cook S, Koskinas KC, Windecker S, Raber L (2016) Mechanisms of very late drug-eluting stent thrombosis assessed by optical coherence tomography. Circulation 133(7):650–660. https://doi.org/10.1161/circulationaha.115.019071 CrossRefPubMed

Nakamura D, Attizzani GF, Toma C, Sheth T, Wang W, Soud M, Aoun R, Tummala R, Leygerman M, Fares A, Mehanna E, Nishino S, Fung A, Costa MA, Bezerra HG (2016) Failure mechanisms and neoatherosclerosis patterns in very late drug-eluting and bare-metal stent thrombosis. Circ Cardiovasc Interv. https://doi.org/10.1161/circinterventions.116.003785 CrossRefPubMed

10.

Lee SY, Ahn JM, Mintz GS, Hur SH, Choi SY, Kim SW, Cho JM, Hong SJ, Kim JW, Hong YJ, Lee SG, Shin DH, Kim JS, Kim BK, Ko YG, Choi D, Jang Y, Park SJ, Hong MK (2017) Characteristics of earlier versus delayed presentation of very late drug-eluting stent thrombosis: an optical coherence tomographic study. J Am Heart Assoc. https://doi.org/10.1161/jaha.116.005386 CrossRefPubMedPubMedCentral

11.

Nakazawa G, Otsuka F, Nakano M, Vorpahl M, Yazdani SK, Ladich E, Kolodgie FD, Finn AV, Virmani R (2011) The pathology of neoatherosclerosis in human coronary implants bare-metal and drug-eluting stents. J Am Coll Cardiol 57(11):1314–1322. https://doi.org/10.1016/j.jacc.2011.01.011 CrossRefPubMedPubMedCentral

12.

Otsuka F, Vorpahl M, Nakano M, Foerst J, Newell JB, Sakakura K, Kutys R, Ladich E, Finn AV, Kolodgie FD, Virmani R (2014) Pathology of second-generation everolimus-eluting stents versus first-generation sirolimus- and paclitaxel-eluting stents in humans. Circulation 129(2):211–223. https://doi.org/10.1161/circulationaha.113.001790 CrossRefPubMed

13.

Lee SY, Hur SH, Lee SG, Kim SW, Shin DH, Kim JS, Kim BK, Ko YG, Choi D, Jang Y, Hong MK (2015) Optical coherence tomographic observation of in-stent neoatherosclerosis in lesions with more than 50% neointimal area stenosis after second-generation drug-eluting stent implantation. Circ Cardiovasc Interv 8(2):e001878. https://doi.org/10.1161/CIRCINTERVENTIONS.114.001878 CrossRefPubMed

14.

Stone GW, Rizvi A, Newman W, Mastali K, Wang JC, Caputo R, Doostzadeh J, Cao S, Simonton CA, Sudhir K, Lansky AJ, Cutlip DE, Kereiakes DJ (2010) Everolimus-eluting versus paclitaxel-eluting stents in coronary artery disease. N Engl J Med 362(18):1663–1674. https://doi.org/10.1056/NEJMoa0910496 CrossRefPubMed

15.

Lee SY, Shin DH, Mintz GS, Kim JS, Kim BK, Ko YG, Choi D, Jang Y, Hong MK (2013) Optical coherence tomography-based evaluation of in-stent neoatherosclerosis in lesions with more than 50% neointimal cross-sectional area stenosis. EuroIntervention 9(8):945–951. https://doi.org/10.4244/eijv9i8a158 CrossRefPubMed

16.

Tearney GJ, Regar E, Akasaka T, Adriaenssens T, Barlis P, Bezerra HG, Bouma B, Bruining N, Cho JM, Chowdhary S, Costa MA, de Silva R, Dijkstra J, Di Mario C, Dudek D, Falk E, Feldman MD, Fitzgerald P, Garcia-Garcia HM, Gonzalo N, Granada JF, Guagliumi G, Holm NR, Honda Y, Ikeno F, Kawasaki M, Kochman J, Koltowski L, Kubo T, Kume T, Kyono H, Lam CC, Lamouche G, Lee DP, Leon MB, Maehara A, Manfrini O, Mintz GS, Mizuno K, Morel MA, Nadkarni S, Okura H, Otake H, Pietrasik A, Prati F, Raber L, Radu MD, Rieber J, Riga M, Rollins A, Rosenberg M, Sirbu V, Serruys PW, Shimada K, Shinke T, Shite J, Siegel E, Sonoda S, Suter M, Takarada S, Tanaka A, Terashima M, Thim T, Uemura S, Ughi GJ, van Beusekom HM, van der Steen AF, van Es GA, van Soest G, Virmani R, Waxman S, Weissman NJ, Weisz G (2012) Consensus standards for acquisition, measurement, and reporting of intravascular optical coherence tomography studies: a report from the International Working Group for Intravascular Optical Coherence Tomography Standardization and Validation. J Am Coll Cardiol 59(12):1058–1072. https://doi.org/10.1016/j.jacc.2011.09.079 CrossRefPubMed

17.

Kume T, Okura H, Kawamoto T, Yamada R, Miyamoto Y, Hayashida A, Watanabe N, Neishi Y, Sadahira Y, Akasaka T, Yoshida K (2011) Assessment of the coronary calcification by optical coherence tomography. EuroIntervention 6(6):768–772. https://doi.org/10.4244/eijv6i6a130 CrossRefPubMed

18.

Regar E, van Beusekom HM, van der Giessen WJ, Serruys PW (2005) Images in cardiovascular medicine. Optical coherence tomography findings at 5-year follow-up after coronary stent implantation. Circulation 112(23):e345–e346. https://doi.org/10.1161/circulationaha.104.531897 CrossRefPubMed

19.

Teramoto T, Ikeno F, Otake H, Lyons JK, van Beusekom HM, Fearon WF, Yeung AC (2010) Intriguing peri-strut low-intensity area detected by optical coherence tomography after coronary stent deployment. Circ J 74(6):1257–1259CrossRefPubMed

20.

Goto I, Itoh T, Kimura T, Fusazaki T, Matsui H, Sugawara S, Komuro K, Nakamura M (2011) Morphological and quantitative analysis of vascular wall and neointimal hyperplasia after coronary stenting: comparison of bare-metal and sirolimus-eluting stents using optical coherence tomography. Circ J 75(7):1633–1640CrossRefPubMed

21.

Takano M, Yamamoto M, Inami S, Murakami D, Ohba T, Seino Y, Mizuno K (2009) Appearance of lipid-laden intima and neovascularization after implantation of bare-metal stents extended late-phase observation by intracoronary optical coherence tomography. J Am Coll Cardiol 55(1):26–32. https://doi.org/10.1016/j.jacc.2009.08.032 CrossRefPubMed

22.

Gonzalo N, Serruys PW, Okamura T, van Beusekom HM, Garcia-Garcia HM, van Soest G, van der Giessen W, Regar E (2009) Optical coherence tomography patterns of stent restenosis. Am Heart J 158(2):284–293. https://doi.org/10.1016/j.ahj.2009.06.004 CrossRefPubMed

23.

Adriaenssens T, Joner M, Godschalk TC, Malik N, Alfonso F, Xhepa E, De Cock D, Komukai K, Tada T, Cuesta J, Sirbu V, Feldman LJ, Neumann FJ, Goodall AH, Heestermans T, Buysschaert I, Hlinomaz O, Belmans A, Desmet W, Ten Berg JM, Gershlick AH, Massberg S, Kastrati A, Guagliumi G, Byrne RA (2017) Optical coherence tomography findings in patients with coronary stent thrombosis: a report of the PRESTIGE consortium (prevention of late stent thrombosis by an Interdisciplinary Global European effort). Circulation 136(11):1007–1021. https://doi.org/10.1161/circulationaha.117.026788 CrossRefPubMedPubMedCentral

24.

Kim JS, Jang IK, Kim JS, Kim TH, Takano M, Kume T, Hur NW, Ko YG, Choi D, Hong MK, Jang Y (2009) Optical coherence tomography evaluation of zotarolimus-eluting stents at 9-month follow-up: comparison with sirolimus-eluting stents. Heart 95(23):1907–1912. https://doi.org/10.1136/hrt.2009.167759 CrossRefPubMedPubMedCentral

25.

Otsuka F, Byrne RA, Yahagi K, Mori H, Ladich E, Fowler DR, Kutys R, Xhepa E, Kastrati A, Virmani R, Joner M (2015) Neoatherosclerosis: overview of histopathologic findings and implications for intravascular imaging assessment. Eur Heart J 36(32):2147–2159. https://doi.org/10.1093/eurheartj/ehv205 CrossRefPubMed

26.

Kang SJ, Mintz GS, Akasaka T, Park DW, Lee JY, Kim WJ, Lee SW, Kim YH, Whan Lee C, Park SW, Park SJ (2011) Optical coherence tomographic analysis of in-stent neoatherosclerosis after drug-eluting stent implantation. Circulation 123(25):2954–2963. https://doi.org/10.1161/circulationaha.110.988436 CrossRefPubMed

Title: Differences between first-generation and second-generation drug-eluting stent regarding in-stent neoatherosclerosis characteristics: an optical coherence tomography analysis
Authors: Norihiro Kobayashi
Yoshiaki Ito
Masahiro Yamawaki
Motoharu Araki
Tsuyoshi Sakai
Masaru Obokata
Yasunari Sakamoto
Shinsuke Mori
Masakazu Tsutsumi
Masahiro Nauchi
Yohsuke Honda
Takahiro Tokuda
Kenji Makino
Shigemitsu Shirai
Keisuke Hirano
Publication date: 01-10-2018
Publisher: Springer Netherlands
Published in: The International Journal of Cardiovascular Imaging / Issue 10/2018
Print ISSN: 1569-5794
Electronic ISSN: 1875-8312
DOI: https://doi.org/10.1007/s10554-018-1375-4

ACC 2024 Congress Coverage

Heart Failure Video

At a glance: The ONWARDS insulin icodec trials

Springer Medicine

Differences between first-generation and second-generation drug-eluting stent regarding in-stent neoatherosclerosis characteristics: an optical coherence tomography analysis

Abstract

ACC 2024 Congress Coverage

Year in Review: Heart failure and cardiomyopathies

Semaglutide benefits people with type 2 diabetes and obesity-related heart failure

Incentivised to exercise

New intervention for STEMI-related cardiogenic shock

» View more highlights on the ACC 2024 congress hub page

At a glance: The ONWARDS insulin icodec trials

Springer Medicine

Abstract

Please log in to get access to this content

Other articles of this Issue 10/2018

Erupted coronary atheroma: insights from multi-modality imaging

Findings on 3D speckle tracking echocardiography in asymptomatic methamphetamine abusers

Variability of native T1 values: implication for defining regional myocardial changes using MRI

Myocardial perfusion reserve and global longitudinal strain as potential markers of coronary allograft vasculopathy in late-stage orthotopic heart transplantation

Diagnostic value of myocardial deformation pattern in children with noncompaction cardiomyopathy

Electrocardiography based prediction of hypertrophy pattern and fibrosis amount in hypertrophic cardiomyopathy: comparative study with cardiac magnetic resonance imaging

ACC 2024 Congress Coverage

Year in Review: Heart failure and cardiomyopathies

Semaglutide benefits people with type 2 diabetes and obesity-related heart failure

Incentivised to exercise

New intervention for STEMI-related cardiogenic shock

» View more highlights on the ACC 2024 congress hub page