Transcript Neointimal Coverage Evaluated by OCT after Sirolimus

NEOINTIMAL COVERAGE EVALUATED
BY OCT AFTER SIROLIMUS-ELUTING
STENT IMPLANTATION
SONG XIANTAO MD
Beijing Anzhen Hospital affiliated to Capital Medical University
 One of the best morphologic predictors of stent
thrombosis is thought to be the extent of uncovered
stent strut surfaces in human autopsy studies.
 Clinical assessment of neointimal coverage over
stent struts has emerged as a potential avenue for
assessing the risk of SES thrombosis.
 OCT can be used to examine changes in neointimal
thickness and stent apposition to the vessel wall in
precise detail.
Finn AV, et al. Circulation 2007;115:2435-2441
Awata M, et al. Circulation 2007;116:910-916
Neointimal coverage of SES 3 months after
implantation
Masamichi Takano, et al. Am J Cardiol 2007;99:1033-1038
Neointimal coverage of SES 3 months after
implantation
 21 lesion 31 SESs
 4516 strut in 567-mm single
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stent segment
NIH: 2941m
NIH area: 10 4%
Exposed struts:15%
Exposed struts with
malapposition: 6%
NIH100 m: 7%
85% of struts surrounding
NIH by OCT
Masamichi Takano, et al. Am J Cardiol 2007;99:1033-1038
Neointimal coverage of SES 6 months after
implantation
 34 patients 57 SESs
 NIH: 52.5m (28.0,147.6)
 9 SES (16%) showed full
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coverage by neointima.
89% had well-apposed
struts with neointima
8% well-apposed struts
without neointima
2% malapposed struts
without neointima
1% a side branch site
Daisuke Matsumoto, et al. Euro Heart J 2007;28:961-967
Neointima
coverage
patterns
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1 well-apposed to vessel wall with neointima
2 well-apposed without neointima
3 malapposed with neointima
4 malapposed without neointima
5 side branch orifice with neointima
6 side branch orifice without neointima
Hiroki Katoh, et al Circ J 2009
13 patients 21 SESs; 2321 struts at 6 months and
2285 struts at 12 months
At 6
months
At 12
months
Struts without
neointimal coverage
10.4%
5.7%
Malapposed struts
1.7%
0.2%
average NIH
112123
m
12013
0m
Struts located at side 24%
branch orifice without
neointima
0
Complete coverage
with neointima
24%
14%
Hiroki Katoh, et al Circ J 2009
 Distribution of neointimal
thickness on SES struts at 6
months and 12 months.
 There was no remarkable
shift in the thickness
distribution between 6
months and 12 months,
but the frequency of
neointimal thickness
greater than 100m was
increased.
Hiroki Katoh, et al Circ J 2009
Ken0ichi Ishigami, et al. Circ J 2009;73:2300-2307
Neointima coverage after different DES
implantation
Authors
DES
Time
NIH
Exposed struts
Naoki
Myioshi,
et al
PES vs. SES
6
months
90m vs. 50m
Well-apposed struts with
neointima:
92.6% vs. 85.8%
Jin –Sun
Kim
PES vs.SES
9
months
J S Kim
ZES vs. SES
9
months
BX Chen
BMS vs. SES
Feng Tian
SES overlap
4.97.9% vs. 12.515.2%
251.2m
vs.85.5 m
0.3% vs. 12.3%
Helios SES
 Manufactured by taking Co-Cr alloy (L605) tube as
the basic material and pre-installed in a balloon
catheter after plating Ti-O.
 The drug layer is composed of a drug carrier, poly-
D L-lactic-co-glycolic acid (PLGA), and an immune
inhibitor drug known as rapamycin.
Helios SES
 A. Neointimal coverage:
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coverage thickness ≥10μm.
B. Delayed vascular neointimal
coverage: coverage thickness of
the strut < 10μm.
C. Incomplete stent apposition
(ISA) with delayed neointimal
coverage.
D.ISA with neointimal coverage.
ISA was defined as a distance
from the medial midpoint of the
stent shadow to the vascular
luminal surface was ≥110µm
Helios SES
 10 case, 296-mm length
(2,063 struts)
 9 months
 All patients had delayed
neointima coverage and ISA
 The average neointima area
percentage was
5.0618±5.6625%, while the
average neointima area of
type A was
8.5732±4.91192%.
 NIH: 40m
Summary
 Neointima coverage (NIH)
 Catch up?
 Should the low rate of neointima coverage lead
us to prolong the dual antiplatelet therapy?
 Fibrin deposition ? Thin endothelia ?
 LSM/Aneurysm
Thank you for your attention!