Stent strut thickness and acute vessel injury during percutaneous coronary interventions: an optical coherence tomography randomized clinical trial.

Abstract

AIMS:

Compare the degree of acute vascular injury caused by a polymer-free, thin-strut drug-eluting stent (DES) to that caused by a bioresorbable polymer, thick-strut DES using optical coherence tomography (OCT).

METHODS AND RESULTS:

Fifty patients requiring nonurgent PCI were randomized to receive either a thin or a thick-strut DES. OCT was performed before and after stent implantation. OCT-based injury score (IS) after implantation was numerically higher within thick-strut stents 0.32 vs. 0.23, but the difference was NS (P = 0.61). Edge dissections were present in 36% of the patients without differences between groups. Tissue prolapse (TP) area was larger with thin-strut stents (2.26 vs. 1.83 mm2, P = 0.04). Stent expansion and symmetry index were similar between the two platforms (85% vs. 94%, P = 0.08; and 0.82 vs. 0.80, P = 0.25). No differences were observed in total malapposition area (1.85 mm2 in thin-strut stents vs. 1.47 mm2, P = 0.48). Regarding the influence of plaque-type, IS tended to be higher (non-significant) with thick strut DES in fibrocalcific plaques. Stent malapposition area was smaller in fibrous plaques, especially with thin strut stents (P = 0.03).

CONCLUSION:

There was no difference in the extent of OCT-based vessel injury associated with thin and thick-strut DES platforms. TP was larger with the thin strut DES, potentially reflecting a deeper stent embedment in the vessel wall.

• Authors: Jean Paul Vilchez-Tschischke, Carlos Salazar, Jorge Gil-Romero, Ricardo Mori, Ivan Nuñez-Gil, Alicia Quirós, Luis Nombela, Maria Del Trigo, Pilar Jimenez-Quevedo, Pablo Salinas, Javier Escaned, Carlos Macaya, Nieves Gonzalo
• Journal: Coronary artery disease (Coron Artery Dis) Vol. 32 Issue 5 Pg. 382-390 (Aug 01 2021) ISSN: 1473-5830 [Electronic] England
• PMID: 32826450 (Publication Type: Journal Article, Randomized Controlled Trial)
• Copyright: Copyright © 2020 Wolters Kluwer Health, Inc. All rights reserved.

Chemical References

• Biodegradable Plastics
• umirolimus
• Sirolimus

Topics

• Aged
• Biodegradable Plastics (pharmacology)
• Coronary Angiography (methods)
• Coronary Artery Disease (diagnosis, surgery)
• Coronary Vessels (diagnostic imaging, injuries, pathology)
• Drug-Eluting Stents (adverse effects, classification)
• Female
• Humans
• Intraoperative Complications (diagnostic imaging, etiology, prevention & control)
• Male
• Outcome Assessment, Health Care
• Percutaneous Coronary Intervention (adverse effects, instrumentation, methods)
• Plaque, Atherosclerotic (diagnostic imaging)
• Sirolimus (analogs & derivatives, pharmacology)
• Tomography, Optical Coherence (methods)
• Vascular System Injuries (diagnostic imaging, etiology, prevention & control)