Analysis of the long-term effects of drug-eluting stents on coronary arterial wall morphology as assessed by virtual histology intravascular ultrasound

Takashi Kubo, Akiko Maehara, Gary S. Mintz, Hector M. Garcia-Garcia, Patrick W. Serruys, Takahiko Suzuki, Volker Klauss, Satoru Sumitsuji, Amir Lerman, Steven P. Marso, M. Pauliina Margolis, James R. Margolis, Michael C. Foster, Bernard De Bruyne, Martin B. Leon, Gregg W. Stone

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Abstract

Background: Animal models show impairment of arterial healing after drug-eluting stents (DES) compared with bare-metal stents (BMS). Virtual histology intravascular ultrasound (VH-IVUS) offers an opportunity to assess lesion morphology in vivo. Methods: We used VH-IVUS in 80 patients to assess long-term (median = 10 months) native artery vascular responses after 76 implantations of DES compared with 32 BMS. The presence of "necrotic core abutting the lumen" was evaluated at baseline and follow-up. Results: At baseline, necrotic core abutting the lumen through the stent struts was observed in 76% of DES and 75% of BMS. Although the percentage of necrotic core within the plaque behind the stents did not change during follow-up in DES (23% [18%, 28%] to 22% [17%, 27%], P = .57) or BMS (22% [19%, 27%] to 20% [12%, 26%], P = .29), necrotic core abutting the lumen through the stent struts decreased more in BMS (75% to 19%, P < .001) than DES (76% to 61%, P = .036) because of the lack of an overlying, protective neointima in DES-treated lesions. Furthermore, within the adjacent reference segments, the incidence of necrotic core abutting the lumen decreased in BMS-treated lesions (proximal 23% to 0%, P = .023; distal 21% to 0%, P = .023), but not in DES (proximal 22% to 17%, P = .48; distal 23% to 21%, P = .82). Conclusions: Serial VH-IVUS analysis of DES-treated lesions showed a greater frequency of unstable lesion morphometry at follow-up compared with BMS. The apparent mechanism was a suppression of the protective neointimal hyperplasia layer coupled with a lack of vulnerable plaque resolution at reference segments in DES compared with BMS.

Original languageEnglish (US)
Pages (from-to)271-277
Number of pages7
JournalAmerican Heart Journal
Volume159
Issue number2
DOIs
StatePublished - Feb 2010

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Drug-Eluting Stents
Stents
Histology
Metals
Neointima
Hyperplasia
Blood Vessels
Animal Models
Arteries

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine

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Analysis of the long-term effects of drug-eluting stents on coronary arterial wall morphology as assessed by virtual histology intravascular ultrasound. / Kubo, Takashi; Maehara, Akiko; Mintz, Gary S.; Garcia-Garcia, Hector M.; Serruys, Patrick W.; Suzuki, Takahiko; Klauss, Volker; Sumitsuji, Satoru; Lerman, Amir; Marso, Steven P.; Margolis, M. Pauliina; Margolis, James R.; Foster, Michael C.; De Bruyne, Bernard; Leon, Martin B.; Stone, Gregg W.

In: American Heart Journal, Vol. 159, No. 2, 02.2010, p. 271-277.

Research output: Contribution to journalArticle

Kubo, T, Maehara, A, Mintz, GS, Garcia-Garcia, HM, Serruys, PW, Suzuki, T, Klauss, V, Sumitsuji, S, Lerman, A, Marso, SP, Margolis, MP, Margolis, JR, Foster, MC, De Bruyne, B, Leon, MB & Stone, GW 2010, 'Analysis of the long-term effects of drug-eluting stents on coronary arterial wall morphology as assessed by virtual histology intravascular ultrasound', American Heart Journal, vol. 159, no. 2, pp. 271-277. https://doi.org/10.1016/j.ahj.2009.11.008
Kubo, Takashi ; Maehara, Akiko ; Mintz, Gary S. ; Garcia-Garcia, Hector M. ; Serruys, Patrick W. ; Suzuki, Takahiko ; Klauss, Volker ; Sumitsuji, Satoru ; Lerman, Amir ; Marso, Steven P. ; Margolis, M. Pauliina ; Margolis, James R. ; Foster, Michael C. ; De Bruyne, Bernard ; Leon, Martin B. ; Stone, Gregg W. / Analysis of the long-term effects of drug-eluting stents on coronary arterial wall morphology as assessed by virtual histology intravascular ultrasound. In: American Heart Journal. 2010 ; Vol. 159, No. 2. pp. 271-277.
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title = "Analysis of the long-term effects of drug-eluting stents on coronary arterial wall morphology as assessed by virtual histology intravascular ultrasound",
abstract = "Background: Animal models show impairment of arterial healing after drug-eluting stents (DES) compared with bare-metal stents (BMS). Virtual histology intravascular ultrasound (VH-IVUS) offers an opportunity to assess lesion morphology in vivo. Methods: We used VH-IVUS in 80 patients to assess long-term (median = 10 months) native artery vascular responses after 76 implantations of DES compared with 32 BMS. The presence of {"}necrotic core abutting the lumen{"} was evaluated at baseline and follow-up. Results: At baseline, necrotic core abutting the lumen through the stent struts was observed in 76{\%} of DES and 75{\%} of BMS. Although the percentage of necrotic core within the plaque behind the stents did not change during follow-up in DES (23{\%} [18{\%}, 28{\%}] to 22{\%} [17{\%}, 27{\%}], P = .57) or BMS (22{\%} [19{\%}, 27{\%}] to 20{\%} [12{\%}, 26{\%}], P = .29), necrotic core abutting the lumen through the stent struts decreased more in BMS (75{\%} to 19{\%}, P < .001) than DES (76{\%} to 61{\%}, P = .036) because of the lack of an overlying, protective neointima in DES-treated lesions. Furthermore, within the adjacent reference segments, the incidence of necrotic core abutting the lumen decreased in BMS-treated lesions (proximal 23{\%} to 0{\%}, P = .023; distal 21{\%} to 0{\%}, P = .023), but not in DES (proximal 22{\%} to 17{\%}, P = .48; distal 23{\%} to 21{\%}, P = .82). Conclusions: Serial VH-IVUS analysis of DES-treated lesions showed a greater frequency of unstable lesion morphometry at follow-up compared with BMS. The apparent mechanism was a suppression of the protective neointimal hyperplasia layer coupled with a lack of vulnerable plaque resolution at reference segments in DES compared with BMS.",
author = "Takashi Kubo and Akiko Maehara and Mintz, {Gary S.} and Garcia-Garcia, {Hector M.} and Serruys, {Patrick W.} and Takahiko Suzuki and Volker Klauss and Satoru Sumitsuji and Amir Lerman and Marso, {Steven P.} and Margolis, {M. Pauliina} and Margolis, {James R.} and Foster, {Michael C.} and {De Bruyne}, Bernard and Leon, {Martin B.} and Stone, {Gregg W.}",
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T1 - Analysis of the long-term effects of drug-eluting stents on coronary arterial wall morphology as assessed by virtual histology intravascular ultrasound

AU - Kubo, Takashi

AU - Maehara, Akiko

AU - Mintz, Gary S.

AU - Garcia-Garcia, Hector M.

AU - Serruys, Patrick W.

AU - Suzuki, Takahiko

AU - Klauss, Volker

AU - Sumitsuji, Satoru

AU - Lerman, Amir

AU - Marso, Steven P.

AU - Margolis, M. Pauliina

AU - Margolis, James R.

AU - Foster, Michael C.

AU - De Bruyne, Bernard

AU - Leon, Martin B.

AU - Stone, Gregg W.

PY - 2010/2

Y1 - 2010/2

N2 - Background: Animal models show impairment of arterial healing after drug-eluting stents (DES) compared with bare-metal stents (BMS). Virtual histology intravascular ultrasound (VH-IVUS) offers an opportunity to assess lesion morphology in vivo. Methods: We used VH-IVUS in 80 patients to assess long-term (median = 10 months) native artery vascular responses after 76 implantations of DES compared with 32 BMS. The presence of "necrotic core abutting the lumen" was evaluated at baseline and follow-up. Results: At baseline, necrotic core abutting the lumen through the stent struts was observed in 76% of DES and 75% of BMS. Although the percentage of necrotic core within the plaque behind the stents did not change during follow-up in DES (23% [18%, 28%] to 22% [17%, 27%], P = .57) or BMS (22% [19%, 27%] to 20% [12%, 26%], P = .29), necrotic core abutting the lumen through the stent struts decreased more in BMS (75% to 19%, P < .001) than DES (76% to 61%, P = .036) because of the lack of an overlying, protective neointima in DES-treated lesions. Furthermore, within the adjacent reference segments, the incidence of necrotic core abutting the lumen decreased in BMS-treated lesions (proximal 23% to 0%, P = .023; distal 21% to 0%, P = .023), but not in DES (proximal 22% to 17%, P = .48; distal 23% to 21%, P = .82). Conclusions: Serial VH-IVUS analysis of DES-treated lesions showed a greater frequency of unstable lesion morphometry at follow-up compared with BMS. The apparent mechanism was a suppression of the protective neointimal hyperplasia layer coupled with a lack of vulnerable plaque resolution at reference segments in DES compared with BMS.

AB - Background: Animal models show impairment of arterial healing after drug-eluting stents (DES) compared with bare-metal stents (BMS). Virtual histology intravascular ultrasound (VH-IVUS) offers an opportunity to assess lesion morphology in vivo. Methods: We used VH-IVUS in 80 patients to assess long-term (median = 10 months) native artery vascular responses after 76 implantations of DES compared with 32 BMS. The presence of "necrotic core abutting the lumen" was evaluated at baseline and follow-up. Results: At baseline, necrotic core abutting the lumen through the stent struts was observed in 76% of DES and 75% of BMS. Although the percentage of necrotic core within the plaque behind the stents did not change during follow-up in DES (23% [18%, 28%] to 22% [17%, 27%], P = .57) or BMS (22% [19%, 27%] to 20% [12%, 26%], P = .29), necrotic core abutting the lumen through the stent struts decreased more in BMS (75% to 19%, P < .001) than DES (76% to 61%, P = .036) because of the lack of an overlying, protective neointima in DES-treated lesions. Furthermore, within the adjacent reference segments, the incidence of necrotic core abutting the lumen decreased in BMS-treated lesions (proximal 23% to 0%, P = .023; distal 21% to 0%, P = .023), but not in DES (proximal 22% to 17%, P = .48; distal 23% to 21%, P = .82). Conclusions: Serial VH-IVUS analysis of DES-treated lesions showed a greater frequency of unstable lesion morphometry at follow-up compared with BMS. The apparent mechanism was a suppression of the protective neointimal hyperplasia layer coupled with a lack of vulnerable plaque resolution at reference segments in DES compared with BMS.

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