Author + information
- Takuya Tsujimura1,
- Takayuki Ishihara1,
- Osamu Iida1,
- Shin Okamoto1,
- Kiyonori Nanto1,
- Shota Okuno1 and
- Masaaki Uematsu1
The first generation sirolimus-eluting stent (Cypher, C-SES) has shown neoatherosclerosis in the early phase, resulting in the late stent failure. Second generation zotarolimus-eluting (Endeavor, E-ZES) stent has revealed better arterial healing in the early phase but has shown greater late lumen loss. Nonetheless, neoatherosclerosis following E-ZES has not been well elucidated.
We angioscopically compared 33 E-ZES from 23 patients with 46 C-SES from 25 patients. Angioscopy was done beyond 1 year from the implantation (follow-up duration: 954 ± 375 days versus 933 ± 426 days, P=0.36). We assessed yellow color grade of the stented segment, dominant neointimal coverage (NIC) grade through the stent, and the presence of thrombus. The yellow color grade was graded; grade 0, white; grade 1, light yellow; grade 2, yellow; grade 3, bright yellow. NIC was graded as; grade 0, stent struts exposed; grade 1, struts bulged into the lumen, although covered; grade 2, struts embedded by the neointima, but translucent; grade 3, struts fully embedded and invisible.
Maximus yellow color grade was significantly lower in E-ZES compared to C-SES (see figure, P=0.003). The dominant NIC was significantly greater in E-ZES than in C-SES (E-ZES: grade 0, 0%; grade 1, 0%; grade 2, 18%; grade 3, 82%; C-SES: grade 0, 0%; grade 1, 65%; grade 2, 22%; grade 3, 13%, P<0.001). Thrombus adhesion was statistically not different between them (15% versus 33%, P=0.08).
E-ZES revealed the lower yellow grade and the better arterial healing in the stented segments beyond one year following implantation. Neoatherosclerosis may occur less frequently following E-ZES implantation than C-SES.