Circulation Journal
Online ISSN : 1347-4820
Print ISSN : 1346-9843
ISSN-L : 1346-9843
Ischemic Heart Disease
Long-Term Follow-up of Neointimal Coverage of Sirolimus-Eluting Stents
Evaluation With Optical Coherence Tomography
Ken-ichi IshigamiShiro UemuraYoshinobu MorikawaTsunenari SoedaSatoshi OkayamaTaku NishidaYasuhiro TakemotoKenji OnoueSatoshi SomekawaYukiji TakedaHiroyuki KawataManabu HoriiYoshihiko Saito
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2009 Volume 73 Issue 12 Pages 2300-2307


Background: Late stent thrombosis related to delayed neointimal growth is a major concern after drug-eluting stent (DES) implantation. The time course of neointimal growth and risk factors of uncovered stent struts after sirolimus-eluting stent (SES) was studied using optical coherence tomography (OCT). Methods and Results: The 60 patients were enrolled and classified into G1 (follow-up period <9 months, n=27), G2 (9-24 months, n=18), and G3 (>25 months, n=15). The time elapsed since SES implantation was associated with a significant increase in mean neointimal area and neointimal thickness, and also with a significant decrease in the number of uncovered stent struts (G1: 14.8%, G2: 11.7%, and G3: 4.1%, P<0.001). However, only 17.6% of implanted SES was completely covered by neointima, even in the G3 period. Small-diameter SES, complex coronary lesions with lipid and calcium content adjacent to stent struts, and diabetes predicted delayed neointimal coverage of SES struts in G1. Conclusions: Neointima inside SES progressively increases after the routine follow-up period, but only a few SES were completely covered at 3 years after implantation. OCT is a useful modality for assessing neointimal formation after SES implantation, and may give important information about the strategy of antiplatelet therapy after DES implantation. (Circ J 2009; 73: 2300-2307)

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