Endothelialization of Nonapposed Stent Struts Located over the Origin of a Side Branch: Results with Different Carbofilm‐Coated Stents

Prado, Armando Pérez de; Pérez-Martínez, Claudia; Ramón, Carlos Cuellas; Orden, José Manuel Gonzalo; Altónaga, José R.; Iglesias, María José García; Purriños, Marta Regueiro; Orden, M. A.; Marı́n, Juan Francisco Garcı́a; Fernández‐Vázquez, Felipe

doi:10.1111/j.1540-8183.2009.00458.x

Cited by 18 publications

(14 citation statements)

References 33 publications

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“…4 Our data coincide with the results presented by Gutiérrez-Chico et al 1 : Nonapposed side-branch struts show delayed endothelialization but a parallel time course to the rest of struts. The endothelial cells that cover these nonapposed struts necessarily come from circulating endothelial progenitor cells because there is no chance of repopulation from the surrounding area.…”

supporting

confidence: 82%

Letter by Pérez de Prado et al Regarding Article, “Delayed Coverage in Malapposed and Side-Branch Struts With Respect to Well-Apposed Struts in Drug-Eluting Stents: In Vivo Assessment With Optical Coherence Tomography”

Prado¹,

Cuellas-Ramón²,

Fernández‐Vázquez

2012

Circulation

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We read with great interest the article by Gutiérrez-Chico et al, 1 which reports delayed coverage of incompletely apposed and nonapposed side-branch struts with respect to well-apposed struts in drug-eluting stents as assessed by optical coherence tomography. The relationship between incomplete stent apposition and delayed strut coverage has previously been explored. However, the study of fate of nonapposed side-branch struts is quite original.These struts, placed across the origin of side branches, have systematically been excluded from analysis in most of the published optical coherence tomography studies. Intuitively, they were deemed not suitable to be covered. These new results abrogate that theory, demonstrating by optical coherence tomography analysis that up to 78.1% of these struts appear covered 9 to 13 months after drugeluting stent implantation. This finding is indeed relevant, but a question arises: What is covering those struts? As the authors acknowledge, optical coherence tomography covering is not a surrogate for neointimal healing. The vascular healing process involves the participation of the coagulation system and many types of cells in different phases, all of them covering the stent struts. Optical coherence tomography is unable to distinguish between fibrin, giant cells, granulomatous reaction, and degree of endothelialization. 2 Until we can confirm recent findings with optical density analysis that claims being able to distinguish between neointima and fibrin/thrombus, 3 we can only search for clues. Can the authors offer any extra information that helps in this endeavor? Is there any difference in the thickness of the coverage between apposed and nonapposed struts?We have previously reported that these nonapposed side-branch struts show a high reendothelialization rate in a swine coronary model. 4 Our data coincide with the results presented by Gutiérrez-Chico et al 1 : Nonapposed side-branch struts show delayed endothelialization but a parallel time course to the rest of struts. The endothelial cells that cover these nonapposed struts necessarily come from circulating endothelial progenitor cells because there is no chance of repopulation from the surrounding area. The animal models use young, healthy individuals as opposed to human patients with defective healing mechanisms. Whether these findings predict a similar behavior in the clinical setting is still unknown.It is common to observe nonapposed struts placed over the side-branch origin; up to 41% of the analyzed stents were nonapposed. 1 In daily practice, the rate should be even higher because the analysis refers to randomized studies with moderate stent lengths. Therefore, the clinical relevance of the status of these struts is not negligible. Whatever the coverage of these struts is, some issues must be considered. One of them emerges from the use of the new bioresorbable scaffolds. The struts of these prostheses, also those located over the side-branch takeoff, finally disappear as expected. 5 Do they show a strut coverage si...

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supporting

confidence: 82%

Letter by Pérez de Prado et al Regarding Article, “Delayed Coverage in Malapposed and Side-Branch Struts With Respect to Well-Apposed Struts in Drug-Eluting Stents: In Vivo Assessment With Optical Coherence Tomography”

Prado¹,

Cuellas-Ramón²,

Fernández‐Vázquez

2012

Circulation

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“…Principal characteristics of the polymer‐free amphilimus‐eluting stent. The coronary stent platform is made from a thin‐strut (80 μm) cobalt‐chromium alloy, coated with a passive ultra‐thin (<0.3 mm) layer that optimizes hemocompatibility (bio‐inducer surface) to accelerate endothelialization . Sustained and homogeneous release of sirolimus (90 pg/cm 2 ) is facilitated according to Fick's law and completed over 90 days by laser‐dug wells on the stent surface (abluminal reservoirs) that are filled with a mixture of the drug and long‐chained fatty acids (amphilimus formulation).…”

Section: Discussionmentioning

confidence: 99%

One‐year clinical outcomes of patients treated with polymer‐free amphilimus‐eluting stents or zotarolimus‐eluting stents: A propensity‐score adjusted analysis

Rozemeijer

Muiden

Koudstaal

et al. 2019

Cathet Cardio Intervent

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Background Polymer‐free amphilimus‐eluting stents (PF‐AES) represent a novel elution‐technology in coronary stenting. We aimed to assess 1‐year clinical outcomes of PF‐AES as compared to latest‐generation permanent polymer zotarolimus‐eluting stents (PP‐ZES) in a real‐world all‐comers setting. Methods A prospective registry of patients treated with either PF‐AES or PP‐ZES between 2014 and 2016 was conducted. The primary outcome was defined as major adverse cardiac and cerebrovascular events (MACCE), and the secondary outcome was defined as target‐lesion failure (TLF) at 1 year. To account for measured confounders, a propensity‐score adjusted Cox proportional‐hazard model was built to evaluate clinical outcomes. Results A total of 734 consecutive patients with 1,269 DES implantations were enrolled. The population was characterized by 28% diabetes, 24% ST‐segment elevation myocardial infarction, and a high number of complex lesions (69%). The rate of MACCE was 11.5% for PF‐AES and 13.6% for PP‐ZES, p log‐rank = 0.11. TLF was numerically lower in PF‐AES as compared to PP‐ZES (5.4 vs. 6.1%, p log‐rank = 0.68). After propensity‐score adjustment, PF‐AES showed a trend toward a lower rate of MACCE and a favorable rate of TLF as compared to PP‐ZES (HR 0.70; 95%CI 0.45 to 1.10, P = 0.12; and HR 0.88; 95%CI 0.47 to 1.65, P = 0.68, respectively). Rates of definite ST were low (0.8 vs. 0.3%, p log‐rank = 0.62). Conclusions Our study suggests that implantation of PF‐AES was safe and effective in real‐world patients, with low‐rates of MACCE and TLF at 1 year. Our data needs to be confirmed by a large trial to evaluate the clinical outcomes of this novel polymer‐free, eluting‐technology used in PF‐AES.

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“…Stent strut coverage in general and at bifurcations has been studied using OCT and light and electron microscopy . To our knowledge, this is the first study comparing SEM with frequency‐domain OCT in imaging bifurcation stents.…”

Section: Discussionmentioning

confidence: 99%

Comparison of scanning electron microscopy and optical coherence tomography for imaging of coronary bifurcation stents

Silva¹,

Gahremanpour²,

Attizzani

et al. 2015

Cathet Cardio Intervent

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Endothelialization of Nonapposed Stent Struts Located over the Origin of a Side Branch: Results with Different Carbofilm‐Coated Stents

Abstract: Carbofilm-coated stent struts located over the origin of side branches follow the pattern of endothelialization for the rest of the stent, even in the case of tacrolimus-eluting stent.

Cited by 18 publications

References 33 publications

Letter by Pérez de Prado et al Regarding Article, “Delayed Coverage in Malapposed and Side-Branch Struts With Respect to Well-Apposed Struts in Drug-Eluting Stents: In Vivo Assessment With Optical Coherence Tomography”

Letter by Pérez de Prado et al Regarding Article, “Delayed Coverage in Malapposed and Side-Branch Struts With Respect to Well-Apposed Struts in Drug-Eluting Stents: In Vivo Assessment With Optical Coherence Tomography”

One‐year clinical outcomes of patients treated with polymer‐free amphilimus‐eluting stents or zotarolimus‐eluting stents: A propensity‐score adjusted analysis

Comparison of scanning electron microscopy and optical coherence tomography for imaging of coronary bifurcation stents

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