Serial long-term evaluation of neointimal stent coverage and thrombus after sirolimus-eluting stent implantation by use of coronary angioscopy |
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Authors: | Takano Masamichi Yamamoto Masanori Xie Yong Murakami Daisuke Inami Shigenobu Okamatsu Kentaro Seimiya Koji Ohba Takayoshi Seino Yoshihiko Mizuno Kyoichi |
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Institution: | Department of Internal Medicine, Chiba-Hokusoh Hospital, Nippon Medical School, 1715 Kamakari, Imba, Chiba, 270-1694, Japan. takanom@nms.ac.jp |
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Abstract: | ObjectiveProgression of neointimal stent coverage (NSC) and changes in thrombus were evaluated serially by coronary angioscopy for up to 2?years after sirolimus‐eluting stent (SES) implantation.MethodsSerial angioscopic observations were performed in 20 segments of 20 patients at baseline, at 6?months and at 2?years after SES implantation. NSC was classified as follows: 0, uncovered struts; 1, visible struts through thin neointima; or 2, no visible struts. In each patient, maximum and minimum NSC was evaluated. Existence of thrombus was also examined.ResultsThe maximum NSC increased from 6?months to 2 years (mean (SD) 1.2 (0.4) vs 1.8 (0.4), respectively, p?=?0.005), while the minimum NSC did not change (0.7 (0.5) vs 0.8 (0.4), respectively, p?=?0.25). The prevalence of patients with uncovered struts did not decrease from 6?months to 2?years (35% vs 20%, respectively, p?=?0.29). Although there were no thrombus‐related adverse events, new thrombus formation was found in 5% of 6‐month, and in 20% of 2‐year follow‐up evaluations. The prevalence of thrombus inside the SES at baseline, 6?months and 2?years was similar (40%, 40% and 30%, respectively; p?=?NS).ConclusionsNeointimal growth inside the SES progressed heterogeneously. Uncovered struts persisted in 20% of the patients for up to 2?years and subclinical thrombus formation was not uncommon.Recently, occurrence of late stent thrombosis (LST) after drug‐eluting stent implantation has became a major clinical concern.1,2,3 A long‐term follow‐up study demonstrated that LST occurs at a constant rate of 0.6% a year for up to 3?years after drug‐eluting stent implantation.3 Pathological investigation showed that delayed arterial healing, characterised by an incomplete endothelialisation and persistence of fibrin, has a key role in the occurrence of LST.4,5 Moreover, a powerful predictor of LST is the existence of uncovered struts without endothelialisation.5 We therefore suggested that the uncovered struts of a sirolimus‐eluting stent (SES) remain for an extended period of time.Coronary angioscopy provides direct visualisation of the lumen and detailed information on the condition of neointimal stent coverage (NSC) and thrombus.6,7,8 This imaging modality has the advantage of allowing the identification of an intracoronary thrombus.8 Presently, no long‐term angioscopic follow‐up data after SES implantation are available. Here we present our findings from angioscopic examination, focusing on the long‐term serial changes in the NSC, especially the uncovered stent struts, and the presence of thrombus inside the SES. |
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