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.

doi:10.1016/j.ahj.2009.11.008

« Previous Next »American Heart Journal
Volume 159, Issue 2 , Pages 271-277, February 2010

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

Takashi Kubo, MD, PhD
- Cardiovascular Research Foundation, New York, NY
Akiko Maehara, MD
- Cardiovascular Research Foundation, New York, NY
- Reprint requests: Akiko Maehara, MD, Cardiovascular Research Foundation, 111 East, 59th St, New York, NY 10022.
Gary S. Mintz, MD
- Cardiovascular Research Foundation, New York, NY
Hector M. Garcia-Garcia, MD, MSc
- Erasmus Medical Center, Thoraxcenter, Rotterdam, The Netherlands
Patrick W. Serruys, MD, PhD
- Erasmus Medical Center, Thoraxcenter, Rotterdam, The Netherlands
Takahiko Suzuki, MD
- Toyohashi Heart Center, Aichi, Japan
Volker Klauss, MD
- Ludwig Maximilian University, Munich, Germany
Satoru Sumitsuji, MD
- Nozaki Tokushukai Hospital, Osaka, Japan
Amir Lerman, MD
- Mayo Clinic College of Medicine, Rochester, MN
Steven P. Marso, MD
- Mid America Heart Institute of Saint Luke's Hospital, Kansas City, MO
M. Pauliina Margolis, MD, PhD
- Volcano Corporation, Rancho Cordova, CA
James R. Margolis, MD
- Miami International Cardiology Consultants, Miami, FL
Michael C. Foster, MD
- South Carolina Heart Center, Columbia, SC
Bernard De Bruyne, MD, PhD
- OLV Hospital, Aalst, Belgium
Martin B. Leon, MD
- Cardiovascular Research Foundation, New York, NY
Gregg W. Stone, MD
- Cardiovascular Research Foundation, New York, NY

Received 23 June 2009; accepted 10 November 2009.

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.