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Optical Coherence Tomography Based Biomechanical Fluid-Structure Interaction Analysis of Coronary Atherosclerosis Progression
Published on: January 15, 2022
Interpreting clinical outcomes using different strut thickness in coronary artery disease: insights from vascular
Ju-Seung Kwun1, Jin Joo Park1, Si-Hyuck Kang1
1Cardiovascular Center, Department of Internal Medicine, Seoul National University Bundang Hospital, Seongnam-si, Republic of Korea.
Insights
Ultrathin-strut sirolimus-eluting stents (BP-SES) showed superior outcomes compared to thick-strut biolimus-eluting stents (BP-BES) due to reduced neointimal hyperplasia. This suggests thinner struts improve long-term vessel patency in coronary artery disease treatment.
Area of Science:
- Cardiovascular Medicine
- Interventional Cardiology
- Biomaterials Science
Background:
- Coronary artery disease (CAD) is a major global health issue requiring interventions like percutaneous coronary intervention (PCI) with drug-eluting stents (DES).
- Biodegradable polymer-coated DES have advanced CAD treatment by mitigating neointimal hyperplasia and improving patient outcomes.
- Previous findings indicate superior long-term results with the ultrathin-strut sirolimus-eluting Orsiro stent (BP-SES) compared to the thick-strut biolimus-eluting BioMatrix stent (BP-BES).
Purpose of the Study:
- To investigate the underlying mechanisms responsible for the observed differences in long-term outcomes between BP-SES and BP-BES.
- To quantitatively assess neointimal hyperplasia, lumen dimensions, and stent healing using advanced imaging modalities.
Main Methods:
- A sub-analysis of the BIODEGRADE trial, a prospective, multi-center, randomized study.
- Comparison of BP-SES and BP-BES in patients undergoing PCI, with follow-up angiography at 18-36 months.
- Quantitative coronary angiography (QCA) and optical coherence tomography (OCT) were employed to evaluate lumen diameter, cross-sectional areas, stent apposition, and coverage.
Main Results:
- BP-SES demonstrated a significantly larger minimal lumen diameter and reduced late lumen loss compared to BP-BES (P=0.005).
- OCT analysis revealed significantly less neointimal hyperplasia in the BP-SES group (P<0.001) compared to the BP-BES group.
- No significant differences were observed in stent strut coverage or inflammation markers between the two stent types.
Conclusions:
- Quantitative coronary angiography and optical coherence tomography analyses indicate reduced neointimal growth with BP-SES compared to BP-BES.
- The findings suggest that stent design, specifically thinner struts, plays a crucial role in enhancing clinical success by minimizing restenosis and promoting long-term vessel patency.
- These results highlight the importance of stent characteristics in optimizing outcomes for patients with coronary artery disease treated with drug-eluting stents.
Background:
Coronary artery disease is a global health concern that necessitates treatments, such as percutaneous coronary intervention (PCI) with drug-eluting stents (DES). Recent advancements in biodegradable polymer-coated DES have improved long-term outcomes by reducing neointimal hyperplasia. Superior long-term outcomes in patients with ultrathin-strut sirolimus-eluting Orsiro stent (BP-SES) compared with those with thick-strut biolimus-eluting BioMatrix stent (BP-BES) have been shown. This study aimed to explore the mechanisms underlying these differences by using quantitative coronary angiography (QCA) and optical coherence tomography (OCT).
Methods:
This sub-analysis of the BIODEGRADE trial, a prospective, randomized, multi-center study, compared BP-SES and BP-BES in patients who underwent PCI between July 2014 and September 2017. Patients with positive stress test results, ischemic symptoms, or those who consented to routine follow-up angiography were included. QCA and OCT were used to evaluate the lumen diameter, cross-sectional areas and stent apposition or coverage. OCT images were analyzed at 1 mm intervals within 5 mm proximal and distal to the stented segment.
Results:
Of the 2,341 patients, 689 underwent follow-up angiography between 18- and 36-months post-PCI, and 929 stents were analyzed via QCA. OCT images of 61 participants were available. The BP-SES group exhibited a significantly larger minimal lumen diameter and reduced late lumen loss compared to the BP-BES group (0.34 ± 0.45 mm vs. 0.42 ± 0.44 mm, P = 0.005). OCT analysis showed significantly less neointimal hyperplasia in the BP-SES group (0.04 ± 0.4 mm2 vs. 0.64 ± 0.54 mm2, P < 0.001), with no significant differences in stent strut coverage or inflammation markers, than in the BP-BES group.
Conclusions:
QCA and OCT analyses revealed less neointimal growth with BP-SES than with BP-BES, without delayed healing or increased inflammation. These findings underscore the importance of stent design characteristics and suggest that thinner struts may enhance clinical success by reducing restenosis and improving long-term vessel patency.
Clinical Trial Registration:
https://clinicaltrials.gov/study/NCT02299011 (NCT02299011).
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