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Published on: May 14, 2013
Assessment of and Factors Contributing to Adequate Endothelization After Drug-Eluting Stent Implantation
Masami Nishino1, Yasuyuki Egami1, Hiroaki Nohara1
1Division of Cardiology, Osaka Rosai Hospital.
Insights
Achieving adequate strut coverage (ASC) after drug-eluting stent (DES) implantation is crucial for preventing thrombus and stabilizing plaque. Ingenious DES types and prasugrel therapy significantly improve chronic adequate endothelization.
Area of Science:
- Cardiovascular Research
- Medical Device Technology
- Interventional Cardiology
Background:
- Adequate endothelization post-drug-eluting stent (DES) implantation is vital for reducing thrombotic risk.
- Adequate strut coverage (ASC) is defined as ≥40 μm by optical coherence tomography, but its functional significance is unclear.
- Coronary angioscopy assesses neointimal function via thrombus detection and plaque color analysis.
Purpose of the Study:
- To evaluate functionally adequate endothelization after DES implantation.
- To identify factors contributing to adequate endothelization.
Main Methods:
- Post hoc analysis of COLLABORATION 1 and 2 studies using serial optical coherence tomography and coronary angioscopy.
- Examination of four DES types: durable polymer everolimus-eluting stent (DP-EES), sirolimus-eluting stent (SES), polymer-free biolimus-coated stent (PF-BCS), and dual-therapy sirolimus-eluting stent (DTS).
- Assessment of correlation between %ASC and functional neointima (no thrombus, white plaque).
Main Results:
- Thrombus and yellow plaque were inversely correlated with %ASC at 12 months.
- %ASC cut-off values were 67% for thrombus prevention and 90% for plaque stabilization.
- Ingenious DES, prasugrel therapy, and hypertension independently predicted chronic adequate endothelization.
Conclusions:
- Functional protection against thrombus requires %ASC ≥67%; plaque stabilization requires ≥90%.
- Ingenious DES and prasugrel use enhance chronic adequate endothelization.
Background:
Adequate endothelization after drug-eluting stent (DES) implantation is essential to reduce thrombotic risk. Adequate strut coverage (ASC) is defined as ≥40 μm on optical coherence tomography, but its functional significance remains uncertain. Coronary angioscopy can assess neointimal function by detecting thrombus and plaque color. This study evaluated functionally adequate endothelization and contributing factors after DES implantation.
Methods And Results:
Post hoc analyses of the COLLABORATION 1 and 2 studies were performed using serial optical coherence tomography and coronary angioscopy 1 and 12 months after DES implantation. Four DES types were examined: durable polymer everolimus-eluting stent (DP-EES); sirolimus-eluting stent (SES); polymer-free biolimus-coated stent (PF-BCS); and dual-therapy sirolimus-eluting stent (DTS). PF-BCS and DTS were classified as "ingenious" DES, and DP-EES and SES were classified as "fundamental." The correlation between the percentage of struts with ≥40 μm coverage (%ASC) and functional neointima (i.e., no thrombus and white plaque) was assessed. Among 150 patients (177 lesions), thrombus and yellow plaque were inversely correlated with %ASC at 12 months. Cut-off values of %ASC were 67% for thrombus prevention and 90% for plaque stabilization. Multivariable analysis identified the use of ingenious DES, prasugrel therapy, and hypertension as independent predictors of chronic adequate endothelization.
Conclusions:
Functional protection against thrombus requires %ASC ≥67%, and plaque stabilization requires ≥90%. The use of ingenious DESs and prasugrel contributes to improved chronic adequate endothelization.
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