Early Vascular Response to Ultrathin Biodegradable Polymer Sirolimus-Eluting Stents for the Treatment of ST-Elevation Myocardial Infarction After Plaque Rupture

Abstract

Recent clinical studies suggest that newer-generation drug-eluting stents that combine ultrathin struts and nanocoating (biodegradable polymer sirolimus-eluting stents, BP-SES) could improve long-term clinical outcomes in patients with ST-elevation myocardial infarction (STEMI) undergoing primary percutaneous coronary intervention (PCI). However, the early vascular response to BP-SES in these patients has not been investigated so far.We examined this response in 20 patients with STEMI caused by plaque rupture using frequency-domain optical coherence tomography (OCT) to understand the underlying mechanisms. Plaque rupture was diagnosed by OCT before PCI with BP-SES implantation was performed. OCT was again performed before the final angiography (post-PCI) and after 2 weeks (2W-OCT).BP-SES placement caused protrusion of atherothrombotic material into the stent lumen and incomplete stent apposition in all patients. After 2 weeks, incomplete stent apposition was significantly reduced (% malapposed struts: post-PCI 4.7 ± 3.3%; 2W-OCT 0.9 ± 1.2%; P < 0.0001), and the percentage of uncovered struts also significantly decreased (% uncovered struts: post-PCI; 69.8 ± 18.3%: 2W-OCT; 29.6 ± 11.0%, P < 0.0001). The maximum protrusion area of the atherothrombotic burden was significantly reduced (post-PCI 1.36 ± 0.70 mm 2 ; 2W-OCT 0.98 ± 0.55 mm 2 ; P = 0.004).This study on the early vascular responses following BP-SES implantation showed rapid resolution of atherothrombotic material and progression of strut apposition and coverage.(UMIN000041324)

Coronary arterial repair in patients with stable angina pectoris or acute coronary syndrome after ultrathin biodegradable polymer sirolimus‐eluting stent implantation at 1‐year follow‐up by coronary angioscopy

“…Miura et al 20 described the uncovered stent strut proportion of 7.7% at 2 weeks after O‐SES implantation, thus showing nearly complete endothelial coverage. Oishi et al 21 reported the uncovered stent strut proportion of 29.6% at 2 weeks after O‐SES in patients with ST‐elevation myocardial infarction, indicating NIC and the elimination of atheromatous plaques in the early phase after O‐SES implantation. Furthermore, Ogura et al 22 reported the uncovered strut proportion of 2.9% at 1 month after O‐SES implantation in patients with SAP, thus describing favorable NIC.…”