Impact of different stent alloys on human vascular response to everolimus‐eluting stent: An optical coherence tomography study: The OCTEVEREST

Abstract

Background New generation drug‐eluting stents (DES) incorporate thinner struts and novel alloys to improve clinical performance. Nevertheless, the impact of novel stent materials and designs on human vascular response to DES remains elusive. We sought to evaluate the in‐vivo coronary artery response to platinum‐chromium (PtCr) versus cobalt‐chromium (CoCr) stents featuring the same durable polymer and antiproliferative drug by optical coherence tomography (OCT). Methods and Results A total of 42 patients with de novo lesions in native coronary vessels was treated with PtCr‐everolimus eluting stent (EES; n = 21) or CoCr‐EES (n = 21). Angiography, intravascular ultrasound, and OCT were performed at the index procedure and 6‐month follow‐up. PtCr‐EES and CoCr‐EES had similar concentric expansion (stent eccentricity index; median 0.91 vs. 0.90, respectively, P = 0.47) and very low rate of strut malapposition (median 1.15 vs. 1.80%, P = 0.92) at post implantation. Proportion of struts embedded in tissue was lower in PtCr‐EES compared to CoCr‐EES (median 2.67 vs. 15.23%, P < 0.001). The primary prespecified end point, the percentage of uncovered struts per patient at 6 months follow‐up, was 8.46% [interquartile range (IQR) = 3.05–17.26] in PtCr‐EES and 5.88% (IQR = 1.35–13.27) in CoCr‐EES (P = 0.36), whereas malapposed struts were observed in 0.00% (IQR = 0.00–0.25) versus 0.48% (IQR = 0.00–1.44), respectively, (P = 0.10). Strut‐level neointimal thickness did not differ between the two platforms (median 0.09 vs. 0.08 mm, P = 0.49). Conclusions Acute and mid‐term responses to EES using PtCr or CoCr platforms were similar, with concentric stent expansion, low malapposition, similar strut coverage and limited amount of neointima. Conversely, at postprocedure, PtCr‐EES had fewer embedded struts compared with CoCr‐EES. © 2012 Wiley Periodicals, Inc.

Early vascular healing after titanium–nitride–oxide-coated stent versus platinum–chromium everolimus-eluting stent implantation in patients with acute coronary syndrome

“…Compared with first-generation DES, new generation DeS with thinner stent platforms, biocompatible polymers and rapid drug elution were designed to facilitate earlier anatomical and functional healing of stented vessels. The current study showed that struts were still inadequately covered in the PtCr-eeS group at 2-month follow-up, which is consistent with previous reports: a similar study comparing neointimal coverage by OCT at 6 months reported equivalent rates of uncovered struts between PtCr-eeS and CoCr-eeS (8.46 and 5.88 %, respectively) [20]. another, larger multi-centre study comparing PtCr-eeS and CoCreeS in 12-month clinical follow-up showed non-inferiority of the PtCr-eeS regarding target vessel failure [21].…”

Randomised study of a bioabsorbable polymer-coated sirolimus-eluting stent: results of the DESSOLVE II trial

“…While the percent of uncovered struts was lower for ZES, 2.1% vs 0.5%, both stents had a low percent of uncovered struts. Strut coverage with APSES is at least comparable, if not numerically higher than with other DES evaluated by the same core laboratory 26,27 .…”

“…The results of OCT analysis were reported on per-patient summaries rather than per-strut. While this approach to OCT data analysis may have limitations, this method is commonly used in reporting OCT results and allows comparability with previously reported studies 26,27 . The main limitation is that lesions with uncovered areas of exactly the same size will weight differently in the analysis depending on the total stented length.…”

Clinical outcomes in 995 unselected real-world patients treated with an ultrathin biodegradable polymer-coated sirolimus-eluting stent: 12-month results from the FLEX Registry

“…In our registry, OCT analysis of the Supraflex SES showed 98.1% strut coverage at 6 months, while it was 91.5% and 94.1% in the PROMUS Element and XIENCE DES, respectively. 28 The Supraflex SES had a favourable healing index of 4.8 (1.0-22.9). Lack of healing and absence of endothelial cell coverage of the stent struts have been strongly associated with DES late thrombosis in human autopsy studies.…”