Coronary Arterial Remodeling and Out-Stent Plaque Change After Drug-Eluting Stent Implantation

– Comparison Between Zotarolimus-Eluting Stents and Paclitaxel-Eluting Stents –

Abstract

Background: Out-stent plaque characteristics and eosinophilic inflammatory response, which correlates with positive remodeling after first-generation drug-eluting stent implantation, may be associated with late restenosis and very late stent thrombosis. The differences of out-stent plaque characteristics were compared between paclitaxel-eluting stents (PES) and zotarolimus-eluting stents (ZES), using integrated backscatter-intravascular ultrasound (IB-IVUS). Methods and Results: Of 78 patients enrolled, 25 receiving PES and 25 receiving ZES had adequate IVUS assessment. Volumetric IVUS analysis was performed after stenting and at 8-month follow-up. Out-stent plaque change in the stented segment was compared on IB-IVUS. The relationship between systemic inflammatory response and out-stent plaque change was evaluated. In PES, vessel volume significantly increased (365–389mm³, P<0.0001), whereas it did not change in ZES (315–314mm³, P=0.81). In culprit lesions at baseline in PES, fibrous plaque tended to increase (3.1–3.6mm², P=0.051) and lipid plaque significantly increased (4.3–5.1mm², P=0.02), whereas in ZES the fibrous plaque significantly increased (2.9–4.0mm², P<0.0001) but lipid plaque significantly decreased (5.1–3.6mm², P<0.0001). Systemic eosinophil increase was significantly correlated with positive remodeling and out-stent lipid plaque increase. Conclusions: Chronic out-stent plaque change in ZES consisted of less positive remodeling and more favorable effects on out-stent plaque characteristics than PES. Systemic eosinophil change might be a marker of out-stent lipid plaque change.  (Circ J 2013; 77: 363–371)