Optical coherence tomography evaluation of late strut coverage patterns between first-generation drug-eluting stents and everolimus-eluting stent

2013 ◽  
Vol 84 (5) ◽  
pp. 720-726 ◽  
Author(s):  
Francisco Javier Toledano Delgado ◽  
Manuel Pan Álvarez-Ossorio ◽  
José Suárez de Lezo Cruz-Conde ◽  
Francisco Mazuelos Bellido ◽  
Miguel Ángel Romero Moreno ◽  
...  
Keyword(s):  
Optical Coherence Tomography ◽  
First Generation ◽  
Drug Eluting Stents ◽  
Optical Coherence ◽  
Drug Eluting

Abstract 11019: Incidence and Predictors for Late Acquired Stent Malapposition of Drug-Eluting-Stents With Second-Generation Permanent and Biodegradable Polymer-Coatings - A Prospective, Randomized Comparison Using Optical Coherence Tomography

Circulation ◽  
2014 ◽  
Vol 130 (suppl_2) ◽  
Author(s):  
Christian Roth ◽  
Clemens Gangl ◽  
Daniel Dalos ◽  
Sabine Scherzer ◽  
Lisa Krenn ◽  
...  
Keyword(s):  
Optical Coherence Tomography ◽  
Biodegradable Polymer ◽  
First Generation ◽  
Second Generation ◽  
Polymer Coatings ◽  
Drug Eluting Stents ◽  
Optical Coherence ◽  
Elective Treatment ◽  
Drug Eluting ◽  
One Year

Introduction: The polymers releasing the drug of first-generation drug-eluting stents (DES) may induce allergic reactions and inflammation, resulting in late-acquired stent malapposition (LASM) with uncoverage of struts, and risk of stent thrombosis. The incidence and predictors of LASM in DES with different polymers designed to improve biocompatibility are unknown. Methods: Fifty patients with 59 lesions of interest were randomized to elective treatment with Everolimus-eluting stents (EES; n=17, 20 lesions)], Zotarolimus-eluting stents (ZES; n=15, 19 lesions), and Biolimus-eluting stents (BES; n=18, 20 lesions) and underwent optical coherence tomography after implantation and after one year. Results: After implantation 29 early stent malappositions (ESM) were documented in 29 lesions (49% of lesions), distributed to 11 lesions treated with EES (55%), 11 with ZES (58%), and 7 with BES (35%; n.s.). After one year 14 late stent malappositions (LSM) in 14 lesions (24%) were detected; nine ESM persisted (EPSM) after one year (1 EES, 6 ZES, 2 BES), whereas 20 ESM resolved. In addition, 9 LASM were documented (5 LASM in early well-apposed Stents, 4 LASM in Stents which also have EPSM). LASM was present in 7 hydrophilic polymer-coated ZESs (37%), in 2 fluoropolymer-coated EESs (10%), and in none of the biodegradable polymer-coated BESs (p=0.003). Independent predictors of LASM were the vessel treated (RCA as vessel with high motion; p<0.022) and type of polymer (biodegradable or permanent; p<0.035). Conclusion: The incidence of ESM and EPSM were similar, whereas the incidence of LASM was different in second-generation DES with different polymers. Biodegradable polymer prevented LASM, stent locations with significant vessel movement (RCA) enhanced LASM.

scholarly journals The role of optical coherence tomography guidance in scaffold versus stent optimization

2020 ◽  
Vol 72 (1) ◽  
Author(s):  
Arif A. Al Nooryani ◽  
Nagwa A. Abdelrahman ◽  
Hatem A. Helmy ◽  
Yehia T. Kishk ◽  
Ayman K. M. Hassan
Keyword(s):  
Decision Making ◽  
Optical Coherence Tomography ◽  
Coronary Intervention ◽  
Drug Eluting Stents ◽  
Optical Coherence ◽  
Total Rate ◽  
Great Ability ◽  
Bioresorbable Scaffolds ◽  
Drug Eluting ◽  
The Impact

Abstract Background Optical coherence tomography showed a great ability to identify adverse features during percutaneous coronary intervention with drug-eluting stents and resulted in better clinical outcomes. The study aimed to assess the impact of optical coherence tomography on intraoperative decision-making during implantation of Absorb bioresorbable scaffolds versus everolimus drug-eluting stents. Results We performed an observational study that included 223 consecutive patients post optical coherence tomography-guided implantation of either Absorb bioresorbable scaffolds (162 patients) or everolimus drug-eluting stents (61 patients). We studied the influence of optical coherence tomography on intraoperative decision-making during implantation of bioresorbable scaffolds versus drug-eluting stents by analyzing the total rate of optical coherence tomography-dependent modifications in each device. After satisfactory angiographic results, the total rate of required intervention for optical coherence tomography detected complications was significantly higher in the bioresorbable scaffolds arm compared to drug-eluting stents arm (47.8% versus 32.9%, respectively; p = 0.019). The additional modifications encompassed further optimization in the case of device underexpansion or struts malapposition, and even stenting in the case of strut fractures, or significant edge dissection. Conclusions Compared to drug-eluting stents, Absord scaffold was associated with a significantly higher rate of optical coherence tomography-identified intraprocedural complications necessitating further modifications. The study provides some hints on the reasons of scaffolds failure in current PCI practice; it offers a new insight for the enhancement of BRS safety and presents and adds to the growing literature for successful BRS utilization.

scholarly journals Μεταλλικές ενδοπροθέσεις που απελευθερώνουν φαρμακευτικές ουσίες στο ενδαγγειακό μοντέλο φλεβών κονίκλου

2013 ◽  
Author(s):  
Παναγιώτης Κίτρου
Keyword(s):  
Optical Coherence Tomography ◽  
Frequency Domain ◽  
Drug Eluting Stents ◽  
Optical Coherence ◽  
Drug Eluting

ΣκοπόςΤο παρόν πρωτόκολλο σχεδιάστηκε προκειμένου να εκτιμήσει την ασφάλεια και τηνfeasibility των μεταλλικών ενδοπροθέσεων που απελευθερώνουν φαρμακευτικές ουσίες(Drug-Eluting Stents, DES) έναντι των απλών μεταλλικών ενδοπροθέσεων (Bare-MetalStents, BMS) στο φλεβικό μοντέλο κονίκλου, χρησιμοποιώντας Οπτική ΣυνεκτικήΤομογραφία (Frequency Domain – Optical Coherence Tomography, FD-OCT).ΜέθοδοιΔεκατρείς λευκοί κόνικλοι Νέας Ζηλανδίας υποβλήθηκαν σε τοποθέτηση μεταλλικώνενδοπροθέσεων που απελευθερώνουν Zotarolimus (Group DES) στη μία κοινή λαγόνιο φλέβακαι απλών μεταλλικών ενδοπροθέσεων (Group BMS) στην απέναντι κοινή λαγόνιο. Ταπρωτογενή καταληκτικά σημεία περιελάμβαναν την τεχνική επιτυχία της τοποθέτησης τωνμεταλλικών ενδοπροθέσεων καθώς και την σύγκριση της νεοενδοθηλιακής υπερπλασίαςανάμεσα στα δύο υπό μελέτη σύνολα με την βοήθεια την οπτικής συνεκτικής τομογραφίας.ΑποτελέσματαΗ τεχνική επιτυχία της τοποθέτησης 13 μεταλλικών ενδοπροθέσεων που απελευθερώνουνφαρμακευτικές ουσίες και 13 απλών μεταλλικών ενδοπροθέσεων ήταν 100% (26/26μεταλλικές ενδοπροθέσεις). Τρεις κόνικλοι πέθαναν (3/13, 23%) μέσα στις πρώτες 45 μέρες.Τα υπόλοιπα 10/13 ζώα (77%) θανατώθηκαν την 90η μέρα από την ημέρα τοποθέτησης τωνμεταλλικών ενδοπροθέσεων. Οι 20 μεταλλικές ενδοπροθέσεις (stents) αφαιρέθηκαν μεεπιτυχία. Επιτυχής FD-OCT πραγματοποιήθηκε σε όλα τα τμήματα των κοινών λαγόνιωνφλεβών που αφαιρέθηκαν, 10 στο Group DES και 10 στο Group BMS. Δεν υπήρξε στατιστικάσημαντική διαφορά στην μέση νεοενδοθηλιακή υπερπλασία ανάμεσα στα δύο σύνολα(3.02±1.19mm2 στο Group DES, έναντι 2.76±1.17mm2 στο Group BMS).ΣυμπέρασμαΣε αυτό το πειραματικό πρωτόκολλο, η τοποθέτηση DES στο φλεβικό αγγειακό σύστημα ήταν δυνατή. Η νεοενδοθηλιακή υπερπλασία ήταν παρόμοια και στα δύο σύνολα μετά από περίοδοελέγχου τριών μηνών.

P3385Difference of vascular healing after percutaneous coronary intervention between 4 kinds of new generation drug-eluting stents: an optical coherence tomography analysis

2019 ◽  
Vol 40 (Supplement_1) ◽  
Author(s):  
Y Matsuhiro ◽  
M Nishino ◽  
H Nakamura ◽  
K Yasumoto ◽  
A Tanaka ◽  
...  
Keyword(s):  
Optical Coherence Tomography ◽  
Biodegradable Polymer ◽  
Neointimal Hyperplasia ◽  
Drug Eluting Stents ◽  
P Value ◽  
Optical Coherence ◽  
Durable Polymer ◽  
Drug Eluting ◽  
New Generation

Abstract Background New generation drug eluting stents (DES) have improved target vessel failure as compared with early generation DES and bare metal stent. Contemporary several new generation DES are different each other regarding strut thickness and drug and polymer type. A little is known about which stent induces a more favorable vascular healing at follow up. Purpose In this study, we compared the vascular healing at 8-month follow up by optical coherence tomography (OCT) between 4 different kinds of new generation DES. Methods We enrolled 112 consecutive patients (121 lesions) who underwent PCI using 4 kinds of new generation DES including biodegradable-polymer everolimus-eluting stents (BP-EES), biodegradable-polymer sirolimus-eluting stents (BP-SES), durable-polymer everolimus-eluting stents (DP-EES) and durable-polymer zotarolimus-eluting stents (DP-ZES) and who underwent 8-month follow up angiogram and OCT between July 2016 and April 2018. We compared the OCT parameters including percentage of covered struts, uncovered struts, well-apposed and uncovered struts, malapposed strut and mean neointimal hyperplasia (NIH) thickness between them. Results BP-EES consisted of 29 lesions, BP-SES consisted of 25 lesions, DP-EES consisted of 38 lesions and DP-ZES consisted of 29 lesions. A total of 734 frames with 5163 struts in BP-EES, 481 frames with 4214 struts in BP-SES, 783 frames with 6119 struts in DP-EES and 583 frames with 4708 struts in DP-ZES were analyzed. As shown in a table, mean NIH thickness was significantly higher in BP-EES and BP-SES. Thus, we compared the OCT parameters between durable-polymer (DP) group including DP-ZES and DP-EES and biodegradable-polymer (BP) group including BP-EES and BP-SES. The percentage of uncovered struts was significantly lower and mean NIH thickness was significantly higher in BP group than DP group. Results of OCT parameters BP-EES (n=29) BP-SES (n=25) DP-EES (n=38) DP-ZES (n=29) P value BP group (n=54) DP group (n=67) P value Covered struts (%) 89.5±13.6 92.4±8.6 85.5±17.5 85.0±17.7 0.29 90.9±11.6 85.3±17.4 0.08 Uncovered struts (%) 8.8±10.8 7.1±8.7 14.5±17.5 15.0±17.7 0.14 8.0±9.9 14.7±17.4 0.03 Well-apposed and uncovered struts (%) 7.9±9.9 5.9±7.7 11.7±13.1 12.3±14.0 0.15 7.0±8.9 11.9±13.4 0.04 Malapposed struts (%) 0.8±1.6 1.3±2.2 2.7±5.8 2.7±4.7 0.33 1.0±1.9 2.7±5.3 0.07 Mean NIH thickness (μm) 102±57 121±48 78±28 88±33 <0.01 111±53 82±31 <0.01 Conclusion The present OCT study demonstrated that delayed neointimal healing characterized by the presence of uncovered struts and lower mean NIH thickness was less common in BP group than DP gruop. Biodegradable-polymer may be more favorable than durable-polymer from the point of view of vascular healing.

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