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Original Articles

Lack of Association Between Large Angiographic Late Loss and Low Risk of In-Stent Thrombus

Angioscopic Comparison Between Paclitaxel- and Sirolimus-Eluting Stents

Masamichi Takano, MD; Masanori Yamamoto, MD; Daisuke Murakami, MD; Shigenobu Inami, MD; Kentaro Okamatsu, MD; Koji Seimiya, MD; Takayoshi Ohba, MD; Yoshihiko Seino, MD and Kyoichi Mizuno, MD

From the Division of Cardiology, Nippon Medical School, Tokyo (M.T., K.M.), and Cardiovascular Center, Chiba-Hokusoh Hospital, Nippon Medical School, Chiba (M.Y., D.M., S.I., K.O., K.S., T.O., Y.S.), Japan.

Correspondence to Masamichi Takano, MD, Division of Cardiology, Nippon Medical School, 1–1-5 Sendagi, Bunkyo-ku, Tokyo, 113-8602, Japan. E-mail takanom{at}nms.ac.jp

Received January 27, 2008; accepted May 30, 2008.

Background— It recently has been hypothesized that a larger late loss may have a protective role against stent thrombosis. The relationship between angiographic late loss and the presence of thrombus based on angioscopic findings within paclitaxel-eluting stents (PES) and sirolimus-eluting stents (SES) was investigated in this study.

Methods and Results— Prospective 6-month follow-up angiographic and angioscopic examinations were performed on 18 patients for PES and on 20 patients for SES. Late loss was measured by quantitative coronary angiography. Angioscopic neointimal stent coverage (NSC) grade was classified as follows: 0=uncovered struts without neointima, 1=visible struts through thin neointima, and 2=no visible struts. In each patient, maximum NSC, minimum NSC, and the existence of thrombus were evaluated. Late loss and maximum NSC were greater in PES than in SES (0.38±0.43 versus 0.10±0.23 mm; P=0.02 and P=0.0004, respectively). Late loss was correlated with maximum NSC (grade 0, 0.06±0.01 mm; grade 1, 0.10±0.05 mm; and grade 2, 0.48±0.46 mm), whereas there was no correlation between late loss and minimum NSC. The prevalence of patients with uncovered struts did not differ (44% of PES, 40% of SES; P=0.78). In-stent thrombus was found more frequently in PES than in SES (72% versus 40%, P=0.046) despite no occurrence of stent thrombosis. Only within PES were thrombi found in the segments of NSC grade 2 associated with large late loss.

Conclusion— The present study suggests that angiographic large late loss was not associated with a low risk of in-stent thrombus.

Key Words: drugs • stents • thrombus

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CLINICAL PERSPECTIVE

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This article has been cited by other articles:

				S. Yokoyama, M. Takano, M. Yamamoto, S. Inami, S. Sakai, K. Okamatsu, S. Okuni, K. Seimiya, D. Murakami, T. Ohba, et al. Extended Follow-Up by Serial Angioscopic Observation for Bare-Metal Stents in Native Coronary Arteries: From Healing Response to Atherosclerotic Transformation of Neointima Circ Cardiovasc Interv, June 1, 2009; 2(3): 205 - 212. [Abstract] [Full Text] [PDF]

				J. D. Abbott Revealing the Silver and Red Lining in Drug-Eluting Stents With Angioscopy Circ Cardiovasc Interv, August 1, 2008; 1(1): 7 - 9. [Full Text] [PDF]