Serial Intravascular Ultrasound Analysis of Peri-Stent Remodeling and Proximal and Distal Edge Effects After Sirolimus-Eluting or Paclitaxel-Eluting Stent Implantation in Patients With Diabetes Mellitus

• Published in: The American journal of cardiology 2009-04, Vol.103 (8), p.1083-1088
• Main Authors: Jensen, Lisette Okkels, MD, PhD, Maeng, Michael, MD, PhD, Mintz, Gary S., MD, Christiansen, Evald Hoej, MD, PhD, Hansen, Knud Noerregaard, MD, Galloe, Anders, MD, PhD, Kelbaek, Henning, MD, DMSci, Lassen, Jens Flensted, MD, PhD, Thuesen, Leif, MD, DMSci, Thayssen, Per, MD, DMSci
• Format: Article
• Language: English
• Subjects: Aged; Angioplasty, Balloon, Coronary; Antibacterial agents; Antibiotics. Antiinfectious agents. Antiparasitic agents; Biological and medical sciences; Cardiology; Cardiology. Vascular system; Cardiovascular; Coronary Restenosis - diagnostic imaging; Coronary Restenosis - etiology; Diabetes; Diabetes Complications - complications; Diabetes. Impaired glucose tolerance; Drug-Eluting Stents - adverse effects; Endocrine pancreas. Apud cells (diseases); Endocrinopathies; Etiopathogenesis. Screening. Investigations. Target tissue resistance; Female; Humans; Immunosuppressive Agents - adverse effects; Male; Medical sciences; Middle Aged; Paclitaxel - adverse effects; Patients; Pharmacology. Drug treatments; Sirolimus - adverse effects; Stents; Taxus; Transplants & implants; Ultrasonic imaging; Ultrasonography, Interventional
• ISSN: 0002-9149; 1879-1913
• DOI: 10.1016/j.amjcard.2008.12.035

Patients with diabetes have an increased risk of in-stent restenosis after coronary stent implantation. Serial intravascular ultrasound was used to study chronic arterial responses and edge effects after implantation of Cypher (Cordis, Johnson & Johnson, Miami Lakes, Florida) or Taxus (Boston Scientific, Maple Grove, Minnesota) stents in diabetic patients. Seventy-four diabetic patients were randomly assigned to Cypher or Taxus stent implantation. Intravascular ultrasound of 5-mm long segments immediately proximal and distal to the stent was performed after the procedure and at the 8-month follow-up. The increase in peri-stent external elastic membrane (EEM) volume was more pronounced in the Taxus group (292.4 ± 132.6 to 309.5 ± 146.8 mm3 ) than in the Cypher group (274.4 ± 137.2 to 275.4 ± 140.1 mm3 ; p = 0.005). Peri-stent plaque volume increased in the Taxus group (152.5 ± 73.7 to 166.1 ± 85.1 mm3 ), but was unchanged in the Cypher group (153.5 ± 75.5 to 151.5 ± 75.8 mm3 ; p = 0.002). In proximal and distal reference segments, mean lumen area decreased within the entire 5-mm edge segment (proximal and distal) because of plaque progression (distal, 5.5 ± 3.6 to 5.8 ± 3.7 mm2 ; p = 0.097; proximal, 8.1 ± 2.7 to 8.7 ± 2.9 mm2 ; p = 0.006) without remodeling (change in EEM) in the Taxus group. Conversely, there were no significant changes in reference-segment EEM or plaque areas in the Cypher group. In conclusion, in diabetic patients, Taxus stent implantation was associated with increased (1) peri-stent EEM volume and peri-stent plaque, and (2) stent edge plaque progression accompanied by lumen reduction without remodeling. These findings were not seen in Cypher stents.