Intimal hyperplasia and vascular remodeling after everolimus-eluting and sirolimus-eluting stent implantation in diabetic patients: the randomized diabetes and drug-eluting stent (DiabeDES) IV intravascular ultrasound trial

Lisbeth Antonsen, Michael Maeng, Per Thayssen, Evald Høj Christiansen, Knud Nørregaard Hansen, Anne Kaltoft, Henrik Steen Hansen, Leif Thuesen, Jens Flensted Lassen, Lisette Okkels Jensen

Publikation: Bidrag til tidsskriftTidsskriftartikelForskningpeer review

Abstrakt

OBJECTIVE: To evaluate the effects of the everolimus-eluting Xience™/Promus™ stent (EES) and the sirolimus-eluting Cypher™ stent (SES) on intimal hyperplasia (IH) in diabetic patients.

BACKGROUND: Patients with diabetes mellitus have increased risk of in-stent restenosis after coronary stent implantation due to intimal hyperplasia (IH).

METHODS: In a sub study of the Randomized Comparison of Everolimus-Eluting and Sirolimus-Eluting Stents in Patients Treated with Percutaneous Coronary Intervention (SORT OUT IV trial), serial intravascular ultrasound (IVUS) 10-month follow-up data were available in 88 patients, including 48 EES and 40 SES treated patients. IVUS endpoints included IH volume, in-stent % volume obstruction and changes in external elastic membrane (EEM) volume.

RESULTS: Compared with the SES group, IH volume was increased in the EES group [median (interquartile range): 2.8 mm(3) (0.0-12.6) vs. 0.0 mm(3) (0.0-1.1), P = 0.001]. In-stent % volume obstruction was increased in EES compared to SES [median (interquartile range): 1.6% (0.0-8.2) vs. 0.0% (0.0-1.0), P = 0.001]. Peri-stent external elastic membrane (EEM) volume: (post procedure vs. follow-up EES [300 mm(3) (219-491) vs. 307 mm(3) (223-482), P = 0.73] and SES [316 mm(3) (235-399) vs. 323 mm(3) (246-404), P = 0.05]) and peri-stent plaque volume: EES [163 mm(3) (103-273) vs. 184 mm(3) (115-291), P = 0.18] and SES [186 mm(3) (139-248) vs. 175 mm(3) (153-243), P = 0.26]) were unchanged in both groups. In the proximal reference segment a significant increase in plaque area was seen in the EES group only, without vascular remodeling.

CONCLUSION: In diabetic patients, EES stent implantation was associated with increased IH volume obstruction without involvement of vascular remodeling.

OriginalsprogEngelsk
TidsskriftCatheterization and cardiovascular interventions : official journal of the Society for Cardiac Angiography & Interventions
Vol/bind83
Udgave nummer6
Sider (fra-til)864-872
ISSN1522-1946
DOI
StatusUdgivet - 2014

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