Key result
The percentage of uncovered sirolimus-eluting stent struts significantly decreased from 14.8% at <9 months to 4.1% at >25 months, though only 17.6% of stents were completely covered at 3 years.
Why the study?
Does the time elapsed since sirolimus-eluting stent implantation improve neointimal coverage in patients with coronary artery disease?
Observational (n=60)
No
Does the time elapsed since sirolimus-eluting stent implantation improve neointimal coverage in patients with coronary artery disease?
Neointimal coverage of sirolimus-eluting stents remains incomplete in a significant proportion of patients even 3 years after implantation, supporting the rationale for prolonged dual antiplatelet therapy.
Answers are grounded in this paper and cite their sources.
Incomplete coverage at 3 years may support prolonged dual antiplatelet therapy; leaves open optimal duration in randomized trials.
BACKGROUND: Late stent thrombosis related to delayed neointimal growth is a major concern after drug-eluting stent (DES) implantation. The time course of neointimal growth and risk factors of uncovered stent struts after sirolimus-eluting stent (SES) was studied using optical coherence tomography (OCT). METHODS AND RESULTS: The 60 patients were enrolled and classified into G1 (follow-up period <9 months, n=27), G2 (9-24 months, n=18), and G3 (>25 months, n=15). The time elapsed since SES implantation was associated with a significant increase in mean neointimal area and neointimal thickness, and also with a significant decrease in the number of uncovered stent struts (G1: 14.8%, G2: 11.7%, and G3: 4.1%, P<0.001). However, only 17.6% of implanted SES was completely covered by neointima, even in the G3 period. Small-diameter SES, complex coronary lesions with lipid and calcium content adjacent to stent struts, and diabetes predicted delayed neointimal coverage of SES struts in G1. CONCLUSIONS: Neointima inside SES progressively increases after the routine follow-up period, but only a few SES were completely covered at 3 years after implantation. OCT is a useful modality for assessing neointimal formation after SES implantation, and may give important information about the strategy of antiplatelet therapy after DES implantation.
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Ishigami et al. (2009) conducted an observational in Coronary artery disease (n=60). Time elapsed since sirolimus-eluting stent implantation vs. <9 months follow-up was evaluated on Percentage of uncovered stent struts (p=<0.001). The percentage of uncovered sirolimus-eluting stent struts significantly decreased from 14.8% at <9 months to 4.1% at >25 months, though only 17.6% of stents were completely covered at 3 years.
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