Interventional Cardiology Department, Cardiovascular Institute, Hospital Clínic, Institut d'Investigacions Biomèdiques August Pi I Sunyer (IDIBAPS), Barcelona, Spain; Charité University Medical Care, Campus Benjamin Franklin, Department of Cardiology, Berlin, Germany.
Interventional Cardiology Department, Cardiovascular Institute, Hospital Clínic, Institut d'Investigacions Biomèdiques August Pi I Sunyer (IDIBAPS), Barcelona, Spain; Division of Cardiology, Department of Internal Medicine, Teikyo University Hospital, Tokyo, Japan.
Cardiovasc Revasc Med. 2021 May;26:17-23. doi: 10.1016/j.carrev.2020.10.020. Epub 2020 Nov 1.
BACKGROUND/PURPOSE: Everolimus-eluting stents (EES) are established as latest generation drug eluting stents. However, optical coherence tomography (OCT) assessment of neointimal distribution after EES implantation is lacking. We aimed to assess the longitudinal neointimal distribution pattern after EES implantation using OCT.
Data from 3 prospective studies (HEAL-EES, REVER and RESERVOIR), including patients with EES implantation and OCT follow-up study, were merged. Analyzed stents were divided into 3 segments of equal length (distal, medial, proximal). Longitudinal neointimal distribution patterns were compared between the 3 segments using generalized estimating equation. Neointimal thickness (NIT), neointimal area obstruction, and uncovered or malapposed struts were analyzed.
In total, 86 patients (92 lesions) were analyzed. Time of OCT follow-up was 9.0 ± 1.5 months. NIT was 101.7 ± 65.4 μm and neointimal obstruction area was 12.2 ± 7.6%. The number of assessed struts was the same in all three segments. NIT tended to be higher at the medial segment (108.8 ± 71.1 μm) compared to distal (103.0 ± 63.4 μm) and proximal (93.3 ± 61.1 μm) (p = 0.076). Neointimal area obstruction was significantly different between the 3 segments (12.4 ± 7.5% [distal], 13.1 ± 7.7% [medial], 11.1 ± 7.5% [proximal]; p = 0.037). In the proximal segment, there was a significantly higher frequency of uncovered struts compared to medial and distal segments (3.9% vs. 2.1% vs. 2.5%, p = 0.009). The distribution of malapposed struts was not significantly different.
Distribution of neointimal hyperplasia seems to be different between stent segments, being higher in the medial segment as compared to proximal and distal. Whether this may reflect a response to local pre-interventional plaque burden centrally covered by the stent should be confirmed in a future study.
As optical coherence tomography based assessment of neointimal distribution after everolimus-eluting stent implantation is lacking, we analyzed data of 86 patients (92 lesions) from 3 prospective trials to evaluate neointimal distribution in distal, medial and proximal stent segments. Neointimal hyperplasia seemed to be different between the three segments, with a higher burden in the medial stent segment. Whether this reflects a response to local pre-interventional plaque burden centrally covered by the stent should be confirmed in a future study.
背景/目的：依维莫司洗脱支架（EES）是最新一代药物洗脱支架。然而，EES 植入后新生内膜的分布情况缺乏光学相干断层扫描（OCT）评估。本研究旨在使用 OCT 评估 EES 植入后的纵向新生内膜分布模式。
合并了 3 项前瞻性研究（HEAL-EES、REVER 和 RESERVOIR）的数据，包括接受 EES 植入和 OCT 随访研究的患者。分析的支架被分为 3 个相等长度的节段（远端、中间、近端）。使用广义估计方程比较 3 个节段之间的纵向新生内膜分布模式。分析新生内膜厚度（NIT）、新生内膜面积阻塞以及未覆盖或对位不良的支架。
共纳入 86 例患者（92 处病变）。OCT 随访时间为 9.0±1.5 个月。NIT 为 101.7±65.4μm，新生内膜阻塞面积为 12.2±7.6%。3 个节段评估的支架数量相同。中间节段的 NIT （108.8±71.1μm）高于远端（103.0±63.4μm）和近端（93.3±61.1μm）（p=0.076）。3 个节段之间的新生内膜面积阻塞存在显著差异（12.4±7.5%[远端]、13.1±7.7%[中间]、11.1±7.5%[近端]；p=0.037）。在近端节段，未覆盖的支架比例明显高于中间和远端节段（3.9%比 2.1%比 2.5%；p=0.009）。对位不良支架的分布无显著差异。
支架节段之间新生内膜增生的分布似乎不同，中间节段的新生内膜增生高于近端和远端节段。这是否反映了支架中央覆盖的局部介入前斑块负荷的反应，需要在未来的研究中加以证实。
由于缺乏依维莫司洗脱支架植入后新生内膜分布的光学相干断层扫描评估，我们分析了 3 项前瞻性试验中 86 例患者（92 处病变）的数据，以评估远端、中间和近端支架节段的新生内膜分布。新生内膜增生在三个节段之间似乎不同，中间节段的负担更高。这是否反映了支架中央覆盖的局部介入前斑块负荷的反应，需要在未来的研究中加以证实。
