Neointimal coverage of sirolimus-eluting stents at 6-month follow-up: evaluated by optical coherence tomography

Matsumoto, Daisuke; Shite, Junya; Shinke, Toshiro; Otake, Hiromasa; Tanino, Yusuke; Ogasawara, Daisuke; Sawada, Takahiro; Paredes, Oscar; Hirata, Ken–ichi; Yokoyama, Mitsuhiro

doi:10.1093/eurheartj/ehl413

Cited by 312 publications

(208 citation statements)

References 26 publications

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“…40 In one study, at six-months follow-up, 89 % of sirolimus-eluting stents (SES) lesions were covered by thin neointima, and 64 % of the stent struts were covered with neointima that had a thickness of less than 100 μm (which would be undetectable by IVUS). 40 Even though the introduction of DES has led to reduced rates of restenosis, this complication following PCI still occurs and our understanding of its pathophysiology is still poor. OCT has helped advance our understanding, with studies demonstrating that stent restenosis is not homogenous.…”

Section: Assessment Of Neointimal Coverage With Optical Coherence Tommentioning

confidence: 99%

Intravascular Ultrasound Versus Optical Coherence Tomography for Coronary Artery Imaging – Apples and Oranges?

Rathod¹,

Hamshere²,

Jones³

et al. 2015

Interventional Cardiology Review

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Coronary angiography has been the gold standard technique for evaluating coronary arterial disease for the past 50 years. Increasingly, however, realisation of the limitations of coronary angiography, mainly the inability to supply information regarding the coronary wall, has prompted the design and development of adjunctive technologies to better evaluate not just luminal disease but also the burden and character of atherosclerotic plaque within the vessel. The development of intracoronary imaging modalities, namely intravascular ultrasound (IVUS) and optical coherence tomography (OCT), has progressed quickly and these technologies now have established roles in the diagnosis and treatment of coronary artery disease. In general, intracoronary devices that can assess the coronary endothelium use either acoustic or optical signals that are received by a coronary catheter (IVUS uses ultrasound, OCT uses near-infrared light).This review addresses these two widely used intracoronary imaging techniques, looking at their clinical applications, recent evidence for their use and describes new developments in the field. Intravascular UltrasoundIn the last 25 years IVUS has been established as the most commonly used intracoronary imaging device. An IVUS system consists of a flexible monorail catheter with an ultrasound transducer at its tip that emits ultrasound waves in the 10-40 MHz range and an electronics console to reconstruct the image (see Figure 1).1 After reflection from tissue, part of the ultrasound energy returns to the transducer and is converted into the image.There are two types of IVUS transducers for clinical use: the mechanical rotating transducer and the electronically switched phased array system.The mechanical transducer uses a single crystal on a rotational device, which visualises the entire vessel in cross-section providing better image quality (compared with phased array technology) of 100-150 μm.2 The main disadvantage of mechanical transducers is the central drive shaft that decreases flexibility and prevents the concurrent use of a central guidewire.3 However, newer rotational IVUS catheters have developed a monorail system that allows for the presence of a central guidewire.Phased array catheters use multiple transducer elements, which are mounted along the circumference of the catheter tip. Each element sends and receives ultrasounds from a sector and multiple sectors are gathered to produce a cross-sectional image of the artery. However, they are disadvantaged by a technically complex set-up, requiring detailed programming; 3 but some of the newer catheters are easier to set up.Intracoronary imaging of coronary vessels by IVUS is performed using standard coronary interventional techniques and equipment (guiding catheter and 0.014 inch angioplasty guidewire) for catheter delivery along the guidewire beyond the target lesion/area of interest. Intravenous heparin and glyceryl trinitrate (nitroglycerin) are routinely administered before imaging. The IVUS catheter is then drawn back across the tar...

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Section: Assessment Of Neointimal Coverage With Optical Coherence Tommentioning

confidence: 99%

Intravascular Ultrasound Versus Optical Coherence Tomography for Coronary Artery Imaging – Apples and Oranges?

Rathod¹,

Hamshere²,

Jones³

et al. 2015

Interventional Cardiology Review

View full text Add to dashboard Cite

show abstract

“…The penetration depth is only 1.5-2 mm, but its resolution is an order of magnitude greater than that of intravascular ultrasound (IVUS) 7,8 . Multiple studies comparing OCT with IVUS conclude that OCT is currently the preferred technique to evaluate neointimal hyperplasia after stent implantation [8][9][10] . Especially in small animals with small vessel diameters, the high resolution of OCT renders it the best imaging modality for the evaluation of restenosis.…”

Section: Validation Of the Oct Techniquementioning

confidence: 99%

Imaging in-stent Restenosis: An Inexpensive, Reliable, and Rapid Preclinical Model

Deuse

Ikeno

Robbins

et al. 2009

JoVE

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Preclinical models of restenosis are essential to unravel the pathophysiological processes that lead to in-stent restenosis and to optimize existing and future drug-eluting stents.A variety of antibodies and transgenic and knockout strains are available in rats. Consequently, a model for in-stent restenosis in the rat would be convenient for pathobiological and pathophysiological studies.In this video, we present the full procedure and pit-falls of a rat stent model suitable for high throughput stent research. We will show the surgical procedure of stent deployment, and the assessment of in-stent restenosis using the most elegant technique of OCT (Optical Coherence Tomography). This technique provides high accuracy in assessing plaque CSAs (cross section areas) and correlates well with histological sections, which require special and time consuming embedding and sectioning techniques. OCT imaging further allows longitudinal monitoring of the development of in-stent restenosis within the same animal compared to one-time snapshots using histology.

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“…In particular, the polymer carrier has been shown to provoke eosinophilic/ heterophilic infiltration and induce a marked inflammatory reaction of the arterial wall 8,23,24 . In addition, delayed healing reactions in response to DES, such as incomplete endothelialization over DES struts, have been detected by invasive approaches (angioscopy and optical coherence tomography) as well as in autopsy studies 9,[25][26] . In short, the combination of physical trauma induced by stent implantation and specific biological reactions after DES implantation might together contribute to coronary aneurysm formation after DES implantation.…”

Section: Discussionmentioning

confidence: 99%

Drug-Eluting Stent (DES) Induced Coronary Artery Aneurysm - A Rare Case Report

et al. 2017

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Introduction:Coronary artery aneurysms after coronary intervention are rare, the incidence of coronary artery aneurysms after DES implantation is low within the first 9 months, with a reported incidence of 0.2% to 2.3%, a rate similar to that reported after bare-metal stent (BMS) implantation (0.3% to 3.9%) in the DES versus BMS randomized trials. Most "aneurysms" are in fact pseudoaneurysms rather than true aneurysms [1][2][3][4] . Residual dissection and deep arterial wall injury (rupture or resection of the vessel media) caused by oversized balloons or stents, high pressure balloon inflations, atherectomy, and laser angioplasty have all been associated with coronary artery aneurysms after coronary intervention 1-3 . Drug-eluting stents (DES), which locally elute antiproliferative drugs, can dramatically inhibit neointimal growth, thereby suppressing restenosis 5,6 , but at the same time potentially causing coronary aneurysms due to other mechanisms, such as delayed reendothelialization, inflammatory changes of the medial wall, and hypersensitivity reactions [7][8][9][10] . These findings may be due to delayed healing secondary to the antiproliferative action of the eluted drug, cell necrosis and/or apoptosis from the antimetabolite effect of the drug, and hypersensitivity reactions to the drug/polymer mixture on the DES 7-9 . Systemic administration of antiinflammatory agents (glucocorticoids and colchicine) after stent implantation may be associated with a greater risk of aneurysm formation. 11 However, the true incidence, clinical course, and treatment of coronary artery aneurysms after DES implantation remain largely unknown.Case Report: Mr. X, 60 years old non smoker, non alcoholic, diabetic, hypertensive businessman got admitted in NICVD with complaint of ischaemic chest pain on minimal exertion for 3 months. ECG was within in normal limit, ETT was positive and Echocardiogram showed Anterior wall hypokinesia with EF-65%. CAG showed Significant long lesion in LAD. Direct stenting to LAD was done at the same setting with Promus Element ( 2.75×38mm, at 18 ATM).Whole procedure was uneventful and patient was discharged from hospital with double antiplatelet coverage. After 10 days of PCI patient got readmitted in hospital with complaints of chest discomfort with high grade fever for 2 days. ECG showed AMI ( Extensive Anterior) indicating involvement of LAD territory with strong suspicion of Sub Acute Stent Thrombosis (SAST). Streptokinase could not be given due to delayed arrival. Patient was treated conservatively with LMWH. Blood and urine culture was negative. Check CAG was done 7 days after readmission showing Patent stent in LAD with aneurysmal dilatation at the distal end of stent in LAD. Drug-Eluting Stent (DES) Induced Coronary

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Neointimal coverage of sirolimus-eluting stents at 6-month follow-up: evaluated by optical coherence tomography

Abstract: At 6 months, most of the SES were covered with thin neointima, but few showed full coverage.

Cited by 312 publications

References 26 publications

Intravascular Ultrasound Versus Optical Coherence Tomography for Coronary Artery Imaging – Apples and Oranges?

Intravascular Ultrasound Versus Optical Coherence Tomography for Coronary Artery Imaging – Apples and Oranges?

Imaging in-stent Restenosis: An Inexpensive, Reliable, and Rapid Preclinical Model

Drug-Eluting Stent (DES) Induced Coronary Artery Aneurysm - A Rare Case Report

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