Coronary artery diseaseSerial Intravascular Ultrasound Analysis of Peri-Stent Remodeling and Proximal and Distal Edge Effects After Sirolimus-Eluting or Paclitaxel-Eluting Stent Implantation in Patients With Diabetes Mellitus
Section snippets
Methods
The DiabeDES trial8 was a nonblinded, randomized, Danish, multicenter IVUS study. Patients were eligible for inclusion if they had diabetes mellitus and angiographically significant coronary stenoses in native coronary arteries (vessel diameter 2.25 to 4.0 mm). This was a substudy of The Danish Organization on Randomized Trials With Clinical Outcome (SORT OUT) II trial14 (Clinicaltrials.gov Identifier NCT00388934). All patients provided written informed consent, and the local institutional
Results
Of 130 patients enrolled in the DiabeDES trial,8 74 had paired (after the procedure and follow-up) IVUS analyses (40 Cypher stents and 34 Taxus stents). The 2 groups were well balanced with respect to clinical and lesion characteristics (Table 1).
IVUS volumetric measurements for patients with complete post–stent implantation and 8-month follow-up studies are listed in Table 2. Postimplantation EEM, stent, and peri-stent plaque (EEM minus stent) volumes were similar in the Cypher and Taxus
Discussion
In the present study, vascular responses and intimal hyperplasia after coronary artery stent placement differed between Cypher and Taxus stents. Diabetic patients treated with Taxus stents had more intimal hyperplasia compared with diabetic patients treated with Cypher stents. Increases in peri-stent EEM volume and peri-stent plaque volume were seen in only diabetic patients treated with Taxus stents. In diabetic patients, Taxus stents were also associated with increased stent edge plaque
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Cited by (14)
A randomized study to compare bioactive titanium stents and Everolimus-eluting stents in diabetic patients (TITANIC XV): 1-year results
2014, Revista Espanola de CardiologiaScaffold and edge vascular response following implantation of everolimus-eluting bioresorbable vascular scaffold: A 3-year serial optical coherence tomography study
2014, JACC: Cardiovascular InterventionsCitation Excerpt :Trials with the Endeavor stent (Medtronic, Minneapolis, Minnesota) demonstrated a reduction in the luminal area at both the proximal and distal edges, mainly due to negative remodeling, plaque growth, and rapid elution of zotarolimus (24,25). However, serial IVUS examination in sirolimus- and everolimus-eluting stents revealed an enlargement of the luminal area at the distal edge (26–28). Our results are in agreement with those of previous reports on metal everolimus-eluting stents (28), with a significant increase in the distal-edge luminal area and a nonsignificant decrease in the proximal edge at 6-month follow-up.
Comparison of edge vascular response after sirolimus- and paclitaxel-eluting stent implantation
2013, International Journal of CardiologyCitation Excerpt :The TAXUS II study showed edge plaque progression in both the slow- and moderate-release groups, accompanied by lumen reduction at the proximal edge without remodeling [10]. Moreover, another study which compared proximal and distal edge effects after SES or PES implantation in patients with diabetes showed that PES implantation was associated with increased stent edge plaque progression accompanied by lumen reduction without remodeling [15]. In the present study, on the other hand, plaque progression with negative remodeling, which might not compensate the lumen reduction, was noted in both edge segments in the PES group, which resulted in increased edge restenosis.
Edge vascular response after percutaneous coronary intervention
2013, JACC: Cardiovascular InterventionsCitation Excerpt :Notably, the EEM remained unchanged at both stent edges. A lumen area increase of 0.4 ± 1.22 mm2 (p = 0.032) was observed only at the distal edge, which was due to a trend toward significant decrease of the plaque area from 5.8 to 5.6 mm2 (35). Diabetic patients have an aggressive form of atherosclerosis compared with non-diabetic persons with a higher risk of target lesion revascularization (TLR) due to angiographic restenosis.
Meta-Analysis of Five Randomized Clinical Trials Comparing Sirolimus- Versus Paclitaxel-Eluting Stents in Patients With Diabetes Mellitus
2010, American Journal of CardiologyCitation Excerpt :Statistical analyses were performed using Stata version 9 (StataCorp LP, College Station, Texas). Of the 687 potentially relevant reports initially screened, a total of 8 trials (10 relevant reports) were initially identified.10–19 Two intravascular ultrasound studies10,11 were then excluded because no data were available on angiographic and clinical outcomes, and another trial12 was excluded because the SES and PES were simultaneously implanted in the same patient with diabetes with multiple coronary artery lesions, which precluded the ability to compare the clinical outcomes between the 2 different drug-eluting stents.
Dye-Staining Angioscopy for Coronary Artery Disease
2015, Current Cardiovascular Imaging Reports