Department of Cardiology, Nishinomiya Municipal Central Hospital, Nishinomiya, Hyogo, Japan.
Department of Cardiovascular Medicine, Osaka University Graduate School of Medicine, Suita, Osaka, Japan.
Catheter Cardiovasc Interv. 2019 Aug 1;94(2):204-209. doi: 10.1002/ccd.28095. Epub 2019 Feb 9.
We aimed to compare the coronary angioscopic appearance of neointimal coverage (NIC) over durable-polymer everolimus-eluting stents (XIENCE-EES) and bioresorbable-polymer everolimus-eluting stents (SYNERGY-EES) 1 year after implantation.
XIENCE-EES and SYNERGY-EES have been developed to prevent delayed arterial healing associated with first generation drug-eluting stents. However, the process of arterial healing after XIENCE-EES and SYNERGY-EES implantation has not been clarified.
Patients who underwent implantation of XIENCE-EES (n = 20) or SYNERGY-EES (n = 20) were enrolled in this study. Coronary angiography and coronary angioscopy were performed 12 ± 1 months after stent implantation. The NIC over the stent was classified into four grades: grade 0, stent struts fully exposed; grade 1, stent struts bulging into the lumen and, still visible; grade 2, stent struts embedded in neointima but still visible; and grade 3, stent struts fully embedded and invisible. Stents exhibiting more than one NIC grade was defined as heterogeneous. Moreover, presence of thrombi was investigated.
The distribution of dominant NIC grade (XIENCE-EES: grade 0, 0%; grade 1, 25%; grade 2, 50%; grade 3, 25%; SYNERGY-EES: grade 0, 0%; grade 1, 5%; grade 2, 15%; grade 3, 80%; P = 0.002) and NIC heterogeneity was significantly different (P = 0.004). Thrombi were more frequent in XIENCE-EES than in SYNERGY-EES (40 versus 10%, respectively; P = 0.03).
Compared with XIENCE-EES, SYNERGY-EES were well covered by neointima and accompanied by fewer thrombi. These findings implied arterial healing of SYNERGY-EES was better than that of XIENCE-EES.
比较 1 年后永久性聚合物依维莫司洗脱支架（XIENCE-EES）和生物可吸收聚合物依维莫司洗脱支架（SYNERGY-EES）的新生内膜覆盖（NIC）的血管镜表现。
XIENCE-EES 和 SYNERGY-EES 的开发旨在预防第一代药物洗脱支架相关的延迟动脉愈合。然而，XIENCE-EES 和 SYNERGY-EES 植入后的动脉愈合过程尚未阐明。
本研究纳入了接受 XIENCE-EES（n=20）或 SYNERGY-EES（n=20）植入的患者。在支架植入后 12±1 个月进行冠状动脉造影和冠状动脉血管镜检查。支架上的 NIC 分为四级：0 级，支架小梁完全暴露；1 级，支架小梁向管腔膨出，仍可见；2 级，支架小梁嵌入新生内膜但仍可见；3 级，支架小梁完全嵌入且不可见。支架表现出不止一种 NIC 等级则定义为异质性。此外，还检查了血栓的存在情况。
优势 NIC 等级的分布（XIENCE-EES：0 级，0%；1 级，25%；2 级，50%；3 级，25%；SYNERGY-EES：0 级，0%；1 级，5%；2 级，15%；3 级，80%；P=0.002）和 NIC 异质性差异有统计学意义（P=0.004）。XIENCE-EES 中的血栓比 SYNERGY-EES 更常见（分别为 40%和 10%；P=0.03）。
与 XIENCE-EES 相比，SYNERGY-EES 被新生内膜更好地覆盖，且血栓较少。这些发现表明 SYNERGY-EES 的动脉愈合情况优于 XIENCE-EES。
