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Ma WR, Li Q, Wang Q, Cheng YW, Nai CS, Wang XY, Li Z, Wang Y, Iqbal J, Bourantas CV, Zhang YJ. Early vascular healing after neXt-generation drug-eluting stent implantation in Patients with non-ST elevation acute Coronary syndrome: a randomized optical coherence Tomography imaging study (EXPECT). THE INTERNATIONAL JOURNAL OF CARDIOVASCULAR IMAGING 2024:10.1007/s10554-024-03258-w. [PMID: 39395073 DOI: 10.1007/s10554-024-03258-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/18/2024] [Accepted: 10/02/2024] [Indexed: 10/14/2024]
Abstract
Early vascular healing after drug-eluting stent (DES) implantation is associated with better outcomes and lower incidence of in-stent thrombosis. To examine vascular healing response in patients with non-ST elevation acute coronary syndrome (NSTE-ACS) undergoing percutaneous coronary intervention (PCI) guided by optical coherence tomography (OCT) versus angiography alone. Sixty patients were randomized 1:1:1 to OCT-guided PCI with 3-month OCT follow-up (O3 group, n = 20), angiography-guided PCI with 3-month OCT follow-up (A3 group, n = 20), or angiography-guided PCI with 6-month OCT follow-up (A6 group, n = 20). The primary endpoint was the proportion of covered struts at 3- or 6-month follow-up. The proportion of covered struts in the O3 group was significantly higher than in the A3 group (95.2% vs. 92.3%, p < 0.001), but lower than in the A6 group (95.2% vs. 97.4%, p < 0.001). The O3 group had a lower proportion of incomplete strut apposition (ISA) than the A3 group (0.46% vs. 0.76%, p = 0.006), and higher than the A6 group (0.46% vs. 0.27%, p = 0.018) at follow-up. The optimal cut-off value of ISA after implantation of DES for predicting stent coverage at 3 and 6-month follow-up was 200 μm and 308 μm, respectively. Only one patient experienced target lesion revascularization in the A3 group during a 3-year clinical follow-up. In patients with NSTE-ACS undergoing PCI with DES, OCT guidance achieved higher strut coverage compared with angiography guidance at 3-month follow-up. However, the difference in the strut coverage between the OCT-guided group and the angiography-guided group at 6 months indicates that the degree of endothelialization may be more time-dependent instead of invasive device guidance.
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Affiliation(s)
- Wen-Rui Ma
- Department of Cardiology, Xuzhou New Health Geriatric Hospital, No.281 North Zhongshan Road, Xuzhou, 221005, Jiangsu, P.R. China
- Department of Cardiology, Xuzhou Cancer Hospital, Xuzhou, Jiangsu, China
| | - Qian Li
- Department of Cardiology, Xuzhou New Health Geriatric Hospital, No.281 North Zhongshan Road, Xuzhou, 221005, Jiangsu, P.R. China
- Department of Cardiology, Xuzhou Cancer Hospital, Xuzhou, Jiangsu, China
| | - Qin Wang
- Department of Cardiology, Xuzhou Medical University, No.281 North Zhongshan Road, Xuzhou, 221005, Jiangsu, P.R. China
| | - You-Wei Cheng
- Department of Cardiology, Xuzhou New Health Geriatric Hospital, No.281 North Zhongshan Road, Xuzhou, 221005, Jiangsu, P.R. China
- Department of Cardiology, Xuzhou Cancer Hospital, Xuzhou, Jiangsu, China
| | - Chang-Sheng Nai
- Department of Cardiology, Xuzhou New Health Geriatric Hospital, No.281 North Zhongshan Road, Xuzhou, 221005, Jiangsu, P.R. China
- Department of Cardiology, Xuzhou Cancer Hospital, Xuzhou, Jiangsu, China
| | - Xin-Yu Wang
- Department of Cardiology, Xuzhou New Health Geriatric Hospital, No.281 North Zhongshan Road, Xuzhou, 221005, Jiangsu, P.R. China
- Department of Cardiology, Xuzhou Cancer Hospital, Xuzhou, Jiangsu, China
| | - Zheng Li
- Department of Cardiology, Xuzhou New Health Geriatric Hospital, No.281 North Zhongshan Road, Xuzhou, 221005, Jiangsu, P.R. China
- Department of Cardiology, Xuzhou Cancer Hospital, Xuzhou, Jiangsu, China
| | - Yang Wang
- National Center for Cardiovascular Diseases, Fuwai Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Javaid Iqbal
- Department of Cardiology, Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, UK
| | - Christos V Bourantas
- Department of Cardiology, Barts Heart Centre, Barts Health NHS Trust, London, UK
| | - Yao-Jun Zhang
- Department of Cardiology, Xuzhou New Health Geriatric Hospital, No.281 North Zhongshan Road, Xuzhou, 221005, Jiangsu, P.R. China.
- Department of Cardiology, Xuzhou Medical University, No.281 North Zhongshan Road, Xuzhou, 221005, Jiangsu, P.R. China.
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Wang Y, Zhang X. Vascular restoration therapy and bioresorbable vascular scaffold. Regen Biomater 2014; 1:49-55. [PMID: 26816624 PMCID: PMC4669005 DOI: 10.1093/rb/rbu005] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2014] [Accepted: 08/22/2014] [Indexed: 12/31/2022] Open
Abstract
This article describes the evolution of minimally invasive intervention technologies for vascular restoration therapy from early-stage balloon angioplasty in 1970s, metallic bare metal stent and metallic drug-eluting stent technologies in 1990s and 2000s, to bioresorbable vascular scaffold (BVS) technology in large-scale development in recent years. The history, the current stage, the challenges and the future of BVS development are discussed in detail as the best available approach for vascular restoration therapy. The criteria of materials selection, design and processing principles of BVS, and the corresponding clinical trial results are also summarized in this article.
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Affiliation(s)
- Yunbing Wang
- National Engineering Research Center For Biomaterials, Sichuan University, Chengdu 610064, China
| | - Xingdong Zhang
- National Engineering Research Center For Biomaterials, Sichuan University, Chengdu 610064, China
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Bedair TM, Cho Y, Park BJ, Joung YK, Han DK. Coating defects in polymer-coated drug-eluting stents. BIOMATERIALS AND BIOMECHANICS IN BIOENGINEERING 2014. [DOI: 10.12989/bme.2014.1.3.131] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
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Attizzani GF, Capodanno D, Ohno Y, Tamburino C. Mechanisms, pathophysiology, and clinical aspects of incomplete stent apposition. J Am Coll Cardiol 2014; 63:1355-67. [PMID: 24530675 DOI: 10.1016/j.jacc.2014.01.019] [Citation(s) in RCA: 93] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/21/2013] [Revised: 12/12/2013] [Accepted: 01/07/2014] [Indexed: 11/25/2022]
Abstract
Incomplete stent apposition (ISA) is characterized by the lack of contact of at least 1 stent strut with the vessel wall in a segment not overlying a side branch; it is more commonly found in drug-eluting stents than bare-metal stents. The accurate diagnosis of ISA, initially only possible with intravascular ultrasound, can currently be performed with higher accuracy by optical coherence tomography, which also enables strut-level assessment due to its higher axial resolution. Different circumstances related both to the index procedure and to vascular healing might influence ISA occurrence. Although several histopathology and clinical studies linked ISA to stent thrombosis, potential selection bias precluded definitive conclusions. Initial studies usually performed single time point assessments comparing overall ISA percentage and magnitude in different groups (i.e., stent type), thus hampering a comprehensive understanding of its relationship with vascular healing. Serial intravascular imaging studies that evaluated vascular response heterogeneity recently helped fill this gap. Some particular clinical scenarios such as acute coronary syndromes, bifurcations, tapered vessels, overlapping stents, and chronic total occlusions might predispose to ISA. Interventional cardiologists should be committed to optimal stent choices and techniques of implantation and use intravascular imaging guidance when appropriate to aim at minimizing acute ISA. In addition, the active search for new stent platforms that could accommodate vessel remodeling over time (i.e., self-expandable stents) and for new polymers and/or eluting drugs that could induce less inflammation (hence, less positive remodeling) could ultimately reduce the occurrence of ISA and its potentially harmful consequences.
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Affiliation(s)
- Guilherme F Attizzani
- Division of Cardiology, Ferrarotto Hospital, University of Catania, Catania, Italy; Division of Interventional Cardiology, Pitangueiras Hospital, Jundiaí, SP, Brazil; Harrington Heart and Vascular Institute, University Hospitals, Case Medical Center, Cleveland, Ohio
| | - Davide Capodanno
- Division of Cardiology, Ferrarotto Hospital, University of Catania, Catania, Italy; Excellence Through Newest Advances (ETNA) Foundation, Catania, Italy.
| | - Yohei Ohno
- Division of Cardiology, Ferrarotto Hospital, University of Catania, Catania, Italy
| | - Corrado Tamburino
- Division of Cardiology, Ferrarotto Hospital, University of Catania, Catania, Italy; Excellence Through Newest Advances (ETNA) Foundation, Catania, Italy
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Shiratori Y, Brugaletta S, Alvarez-Contreras L, Azpeitia Y, Ospino N, Gaido S, Delahanty A, Santos A, Martin-Yuste V, Masotti M, Serruys PW, Windecker S, Sabaté M. One-year head to head comparison of the neointimal response between sirolimus eluting stent with reservoir technology and everolimus eluting stent: an optical coherence tomography study. Catheter Cardiovasc Interv 2013; 82:E428-36. [PMID: 23441068 DOI: 10.1002/ccd.24897] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/24/2012] [Revised: 02/02/2013] [Accepted: 02/18/2013] [Indexed: 11/06/2022]
Abstract
OBJECTIVE to compare the vascular healing process between the sirolimus-eluting NEVO and the everolimus-eluting Xience stent by optical coherence tomography (OCT) at 1-year follow-up. BACKGROUND Presence of durable polymer on a drug-eluting metallic stent may be the basis of an inflammatory reaction with abnormal healing response. The NEVO stent, having a bioresorbable polymer eluted by reservoir technology, may overcome this problem. METHODS All consecutive patients, who received NEVO or Xience stent implantation between September 2010 and October 2010 in our institution, were included. Vascular healing was assessed at 1-year as percentage of uncovered struts, neointimal thickness (NIT), in-stent/stent area obstruction and pattern of neointima. RESULTS A total 47 patients (2:1 randomization, n = 32 NEVO, n = 15 Xience) were included. Eighteen patients underwent angiographic follow-up (eight patients with nine lesions for NEVO vs. 10 patients with 11 lesions for Xience). The angiographic late loss was numerically higher but not statistically different in NEVO compared with Xience treated lesions (0.38 ± 0.47 mm vs. 0.18 ± 0.27 mm; P = 0.171). OCT analysis of 4,912 struts demonstrated similar rates of uncovered struts (0.5 vs. 0.7%, P = 0.462), higher mean NIT (177.76 ± 87.76 µm vs. 132.22 ± 30.91 µm; P = 0.170) and in stent/stent area obstruction (23.02 ± 14.74% vs. 14.17 ± 5.94%, P = 0.120) in the NEVO as compared with Xience. CONCLUSION The NEVO stent with a reservoir technology seems to exhibit more neointimal proliferation as compared to Xience stent. The findings of our study, which currently represent the unique data existing on this reservoir technology, would need to be confirmed in a large population.
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Affiliation(s)
- Yoshitaka Shiratori
- Deparment of Cardiology, Thorax Institute, Hospital Clinic, University of Barcelona, Spain
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Davlouros P, Gizas V, Stavrou K, Raptis G, Alexopoulos D. DES thrombosis related to antiplatelet therapy noncompliance: A consequence of the Greek financial crisis. Int J Cardiol 2013; 168:4497-9. [DOI: 10.1016/j.ijcard.2013.06.121] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/21/2013] [Revised: 05/09/2013] [Accepted: 06/30/2013] [Indexed: 11/25/2022]
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Predominant microvessel proliferation in coronary stent restenotic tissue in patients with diabetes: Insights from optical coherence tomography image analysis. Int J Cardiol 2013; 168:843-7. [DOI: 10.1016/j.ijcard.2012.10.002] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/20/2012] [Revised: 09/23/2012] [Accepted: 10/07/2012] [Indexed: 11/21/2022]
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Incidence and the Clinical Impact of Stent Fractures after Primary Stenting for TASC C and D Femoropopliteal Lesions at 1 Year. Eur J Vasc Endovasc Surg 2013; 46:201-12. [DOI: 10.1016/j.ejvs.2013.05.010] [Citation(s) in RCA: 38] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2012] [Accepted: 05/09/2013] [Indexed: 11/24/2022]
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Coats AJS. Reply to the Hong-Lin Chen article on CONSORT (2010) recommendations. Int J Cardiol 2012; 162:4-5. [PMID: 23138012 DOI: 10.1016/j.ijcard.2012.10.017] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/19/2012] [Accepted: 10/20/2012] [Indexed: 10/27/2022]
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Davlouros PA, Mavronasiou E, Alexopoulos D. Mechanisms of late stent-related myocardial infarction: insights from optical coherence tomography. Interv Cardiol 2012. [DOI: 10.2217/ica.12.71] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
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Khan W, Farah S, Domb AJ. Drug eluting stents: Developments and current status. J Control Release 2012; 161:703-12. [PMID: 22366546 DOI: 10.1016/j.jconrel.2012.02.010] [Citation(s) in RCA: 121] [Impact Index Per Article: 10.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2011] [Revised: 02/07/2012] [Accepted: 02/11/2012] [Indexed: 11/27/2022]
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Reporting in randomized trials published in International Journal of Cardiology in 2011 compared to the recommendations made in CONSORT 2010. Int J Cardiol 2012; 160:208-10. [PMID: 22738783 DOI: 10.1016/j.ijcard.2012.06.045] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/21/2012] [Revised: 05/08/2012] [Accepted: 06/08/2012] [Indexed: 11/21/2022]
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Papayannis AC, Cipher D, Banerjee S, Brilakis ES. Optical coherence tomography evaluation of drug-eluting stents: a systematic review. Catheter Cardiovasc Interv 2012; 81:481-7. [PMID: 22488730 DOI: 10.1002/ccd.24327] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/27/2011] [Accepted: 01/03/2012] [Indexed: 11/08/2022]
Abstract
AIMS We performed a systematic review of studies reporting stent strut coverage and malapposition post implantation of different drug-eluting stent (DES), as assessed by optical coherence tomography (OCT). METHODS A review of publications and online databases in May 2011 retrieved 33 published studies reporting stent strut coverage and malapposition post-DES implantation using OCT: 24 for sirolimus-eluting stents (SES), 13 for paclitaxel-eluting stents (PES), 10 for zotarolimus-eluting stents (ZES), and two for everolimus-eluting stents (EES). The follow-up duration ranged from 3 months to 4 years. Stent strut coverage and malapposition were compared between DES at various time intervals post implantation. RESULTS Significant differences in stent strut coverage and malapposition exist between various DES. The SES had the highest frequency of uncovered struts at 3, 6, 9, and 12 months (13.1%, 10.9%, 8.1%, and 7.5%, respectively), followed by PES (5.5%, 4.4%, and 5.7% at 6, 9, and 12 months, respectively) and ZES (0.7%, 0%, and 0.5% at 3, 6, and 9 months, respectively) (P < 0.001 for all comparisons between stents). Only two studies reported 3.1% uncovered struts at 9 months with the EES. Stent strut malapposition at 6, 9, and 12 months was highest with SES (3.2%, 2.2%, and 1.2%, respectively) followed by PES (1.6%, 1.3%, and 0.9%, respectively), EES (0.46% at 9 months), and ZES (0.7% and 0.1% at 6 and 9 months, respectively). CONCLUSIONS SES had the highest rates of uncovered struts and malapposition, followed by PES and ZES. Such differences may explain the different clinical outcomes between various DES. © 2012 Wiley Periodicals, Inc.
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Gutiérrez-Chico JL, Alegría-Barrero E, Teijeiro-Mestre R, Chan PH, Tsujioka H, de Silva R, Viceconte N, Lindsay A, Patterson T, Foin N, Akasaka T, di Mario C. Optical coherence tomography: from research to practice. Eur Heart J Cardiovasc Imaging 2012; 13:370-84. [PMID: 22330231 PMCID: PMC3342852 DOI: 10.1093/ehjci/jes025] [Citation(s) in RCA: 61] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
Optical coherence tomography (OCT) is a high-resolution imaging technique with great versatility of applications. In cardiology, OCT has remained hitherto as a research tool for characterization of vulnerable plaques and evaluation of neointimal healing after stenting. However, OCT is now successfully applied in different clinical scenarios, and the introduction of frequency domain analysis simplified its application to the point it can be considered a potential alternative to intravascular ultrasound for clinical decision-making in some cases. This article reviews the use of OCT for assessment of lesion severity, characterization of acute coronary syndromes, guidance of intracoronary stenting, and evaluation of long-term results.
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Davlouros PA, Karantalis V, Xanthopoulou I, Mavronasiou E, Tsigkas G, Toutouzas K, Alexopoulos D. Mechanisms of Non-Fatal Stent-Related Myocardial Infarction Late Following Coronary Stenting With Drug-Eluting Stents and Bare Metal Stents - Insights From Optical Coherence Tomography -. Circ J 2011; 75:2789-97. [DOI: 10.1253/circj.cj-11-0581] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
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