Author + information
- 1Morehouse School of Medicine, Atlanta, Georgia, United States
- 2Cardiology, Hamburg, Germany, Asklepios Klinik St. Georg, Hamburg
- 3Ruby hall clinic, pune
- 4University of Arizona, Tucson, Arizona, United States
- 5Emory University / Atlanta VA Medical Center, Atlanta, Georgia, United States
- 6Wakayama medical university
Biocompatible polymers and vascular scaffolds have been attributed to the formation of late stent thrombosis among traditional Drug Eluting Stent (DES). Third generation biodegradable vascular stents (BVS) were developed to overcome this shortcoming. We conducted a meta-analysis to compare the neointimal coverage patterns between BVS and DES using optical coherence tomography (OCT).
We searched PUBMED, COCHRANE and SCOPUS databases for studies comparing the neointimal thickness (NIT) and % uncovered strut per stent (USS) between BVS and DES using OCT. Meta-analysis included randomized control trials and prospective studies where an OCT was performed >6 months after stent deployment. A calculation of weighted standardized mean difference (SMD) in NIT and USS between BVS and DES groups was calculated. Residual maximum likelihood (REML) metaregression was performed on smokers, diabetes mellitus (DM), hypertension, (HTN) dyslipidemia (DLD), and age and sex covariates.
A literature search yielded 394 articles. Studies were excluded if there were no primary outcomes, comparison of BVS and DES, a mean follow up < 6 months and articles written in other languages. 4 studies enrolling 267 patients were included in the meta-analysis. 206 stents and 125874 struts were analyzed by OCT. The median of mean age in years, %male sex, %smokers, %DM, %HTN and %DLD in the BVS group was 63.4 yrs (62.4 – 64.4), 75.6% (68.3 – 82.9), 23.9% (22 – 27.1), 33.3% (26.7 – 35.8), 52.5% (46.6 – 56.6), 51.9% (41.7 – 62.4) vs 63 yrs (62.8 – 64), 77.8% (75.3 – 79.5), 29.1% (19.5 – 36.9), 19.2% (16.1 – 22.1), 62.7% (51.8 – 67.6), 69% (50.3 – 77.3) in the DES group. The unweighted median NIT and USS in the BVS group are 68.7μm (65 – 73.5), 8.3% (3.1 – 13.4) vs 60.8μm (53.8 – 67.1), 14.6% (7.3 – 21.5) in the DES group. The weighted SMD of NIT and USS in the BVS vs DES group are 1.06 (95%CI 0.1, 2.01), P = 0.03 and -1.09 (95% CI -1.7, -0.5). None of the above mentioned covariates accounted for statistical significance.
BVS are significantly associated with a higher NIT and lower USS suggesting superior neointimal coverage in comparison to DES. These findings may suggest that BVS are at a lower risk of developing late stent thrombosis in comparison to DES.
CORONARY: Stents: Bioresorbable Vascular Scaffolds