3-month analysis of neointimal coverage with different profiles stents in stable ischemic heart disease

Introduction. Today, a number of stents are widely used in the world, differing in material, design, drug composition and the content of the polymer coating. The aim of our study is to investigate the processes of neoendothelialization according to optical coherence tomography data in patients with stable coronary heart disease after implantation of various stent platforms. Materials and Methods. This study is a retrospective data analysis of stenting results in patients with stable ischemic heart disease. A total of 69 patients were included in the study. Patients were divided into 3 groups by the type of stent implanted: group 1 everolimus-eluting permanent polymer stent (EES-PP) (n=25), group 2 everolimus-eluting bioabsorbable polymer stent (EES-BP) (n=25) and group 3 sirolimus-eluting bioabsorbable polymer stent (SES-BP) (n=19). The primary endpoint of the study was the Neointimal Healing Score (NHS) 3 months after stent implantation. The secondary endpoint included the percentage of struts covered 3 months after stenting. Results. The percentage of covered strata in the groups did not have a statistically significant difference between the groups and was about 84.2%. Since the length of the implanted stents was slightly higher in the SES-BP group, the difference in the number of strata studied was higher in group 3: 331 versus 175 in group 2 and 175 in group 1 (1–2: p=0.969; 2–3: p<0.001; 1–3: p<0.001). The primary endpoint of the study was significantly lower in the SES-BP group (18±14.97 vs 32.5±20.3 in the EES-BP group and 25.6±12.3 in the EES-PP group), but the NHS in the EES-BP and EES-PP groups was not statistically different. Conclusion. The sirolimus-eluting bioabsorbable polymer (SESBP) stent has a better neointimal healing rate during the first three months compared to the everolimus-eluting bioabsorbable (EES-BP) polymer stent and the permanent polymer everolimus-eluting (EES-PP) stent in patients with stable ischemic heart disease. The percentage of covered strata in the groups does not differ significantly. Further prospective randomized studies with larger samples are needed to confirm the findings.

1. Roth GA, Johnson C, Abajobir A, Abd-Allah F, Abera SF, Abyu G, Ahmed M et al. Global, Regional, and National Burden of Cardiovascular Diseases for 10 Causes, 1990 to 2015. J Am Coll Cardiol. 2017;70(1):1-25. Doi: 10.1016/j.jacc.2017.04.052.

2. Ulrich S. The first clinically used coronary stent was initiated and developed in Lausanne. Cardiovasc Med. 2019;22(1).

3. Parker W, Iqbal J. Comparison of Contemporary Drugeluting Coronary Stents - Is Any Stent Better than the Others? Heart Int. 2020;14(1):34-42. Doi: 10.17925/HI.2020.14.1.34.

4. Suzuki S, Nakatani S, Sotomi Y, Shiojima I, Sakata Y, Higuchi Y. Fate of Different Types of Intrastent Tissue Protrusion: Optical Coherence Tomography and Angioscopic Serial Observations at Baseline and 9-Day and 3-Month Follow-Up. JACC Cardiovasc Interv. 2018;11(1):95-97. Doi: 10.1016/j.jcin.2017.10.012.

5. Hamanaka Y, Sotomi Y, Kobayashi T, Omatsu T, Dijkstra J, Sakata Y, Hirayama A, Hirata A, Higuchi Y. Comparable neointimal healing in patients with stable coronary lesions and acute coronary syndrome: 3-month optical coherence tomography analysis. Int J Cardiovasc Imaging. 2021;37(7):20952105. Doi: 10.1007/s10554-021-02189-0.

6. Varho V, Kiviniemi TO, Nammas W, Sia J, Romppanen H, Pietilä M, Airaksinen JK, Mikkelsson J, Tuomainen P, Perälä A, Karjalainen PP. Early vascular healing after titanium-nitrideoxide-coated stent versus platinum-chromium everolimuseluting stent implantation in patients with acute coronary syndrome. Int J Cardiovasc Imaging. 2016;32(7):1031-1039. Doi: 10.1007/s10554-016-0871-7.

7. Malle C, Tada T, Steigerwald K, Ughi GJ, Schuster T, Nakano M, Massberg S, Jehle J, Guagliumi G, Kastrati A, Virmani R, Byrne RA, Joner M. Tissue characterization after drug-eluting stent implantation using optical coherence tomography. Arterioscler Thromb Vasc Biol. 2013;33(6):1376-1383. Doi: 10.1161/ATVBAHA.113.301227.

8. Lüscher TF, Steffel J, Eberli FR, Joner M, Nakazawa G, Tanner FC, Virmani R. Drug-eluting stent and coronary thrombosis: biological mechanisms and clinical implications. Circulation. 2007;115(8):1051-1058. Doi: 10.1161/CIRCULATIONAHA.106.675934.

9. Taniwaki M, Radu MD, Zaugg S, Amabile N, GarciaGarcia HM, Yamaji K, Jørgensen E, Kelbæk H, Pilgrim T, Caussin C, Zanchin T, Veugeois A, Abildgaard U, Jüni P, Cook S, Koskinas KC, Windecker S, Räber L. Mechanisms of Very Late Drug-Eluting Stent Thrombosis Assessed by Optical Coherence Tomography. Circulation. 2016;133(7):650-660. Doi: 10.1161/CIRCULATIONAHA.115.019071.

10. Nakatani S, Nishino M, Taniike M, Makino N, Kato H, Egami Y, Shutta R, Tanouchi J, Yamada Y. Initial findings of impact of strut width on stent coverage and apposition of sirolimus-eluting stents assessed by optical coherence tomography. Catheter Cardiovasc Interv. 2013;81(5):776-781. Doi: 10.1002/ccd.24401.

11. Ishigami K, Uemura S, Morikawa Y, Soeda T, Okayama S, Nishida T, Takemoto Y, Onoue K, Somekawa S, Takeda Y, Kawata H, Horii M, Saito Y. Long-term follow-up of neointimal coverage of sirolimus-eluting stents--evaluation with optical coherence tomography. Circ J. 2009;73(12):2300-2307. Doi: 10.1253/circj.cj-08-1116.