Abstract:

Aim: was to compare endothelialization of stents with permanent and biodegradable coatings at an early stage with help of optical coherence tomography (OCT).

Materials and methods: this study is a prospective, randomized trial that includes a comparative analysis of OCT data in patients after implantation of coronary stents with biodegradable (study group) and permanent coatings (control group). 98 patients were randomized 1:1 into 2 groups. After 3 months, 10 patients from each group - were randomized to conduct OCT.

Results: we analyzed OCT data of 10 studies in the biodegradable group (1,776 struts and 247 sections) and 10 studies in the permanent coating group (1562 struts and 226 sections). There were no differences in proportion of uncovered (8,9% vs. 8,5%, p=0,49) and non-exposed struts (1,6% vs. 1,3%, p=0,2). Thus, 98,4% of struts in study group and 98.7% in control group were endothelialized.

Conclusions: according to OCT data, similar results were obtained in both groups. After 3 months of observation in two groups, the overwhelming number of struts were endothelialized. At the early stage of observation, none of groups, achievement of endpoints was detected. 

References

1.     Mauri L., Kereiakes D., Yeh R. et al. Twelve or 30 Months of Dual Antiplatelet Therapy after Drug-Eluting Stents. N Engl J Med. 2014; 371:2155-2166.

2.     Authors/Task Force members , Windecker S., Kolh P., et al. ESC/EACTS Guidelines on myocardial revascularization: The Task Force on Myocardial Revascularization of the European Society of Cardiology (ESC) and the European Association for Cardio-Thoracic Surgery (EACTS) Developed with the special contribution of the European Association of Percutaneous Cardiovascular Interventions (EAPCI). Eur Heart J. 2014;35:2541-619.

3.     Kim S., Kim J.S., Shin D.H., et al. Comparison of early strut coverage between zotarolimus- and everolimus-eluting stents using optical coherence tomography. Am J Cardiol. 2013;111:1-5.

4.     Izumi D., Miyahara M., Sakai M., Fukuoka S. OCT- based comparison of early strut coverage between zotarolimus- and everolimus-eluting stents with second stent designs. Eurointervention. 2014;5;20.

5.     Ormiston J., Webster M., Stewart J. et al. First-inHuman Evaluation of a Bioabsorbable Polymer-Coated Sirolimus-Eluting Stent. JACC: Cardiovasc int 2013; 6(10): 1026-1034.

6.     Karjalainen P, Varho V., Nammas W. et al. Early Neointimal Coverage and Vasodilator Response Following Biodegradable Polymer Sirolimus-Eluting vs. Durable Polymer Zotarolimus-Eluting Stents in Patients With Acute Coronary Syndrome. Circulation Journal .2015;79(2): 360-367. 

Abstract:

Aim: was to provide design and direct clinical outcomes of ORENBURG (Optimal dRug Eluting steNts implantation guided By combination of intravascular Ultrasound and optical coheRence tomoGraphy) - single-center randomized clinical trial.

Materials and methods: 1032 patients were included in this study These patients were treatec with 6 types of drug eluting stents. Patients were randomized not only to the type of implanted stent, but also to the type of guidance of the procedure: intravascular ultrasound (IVUS) - 676 patients, quantitative coronary arteriography (QCA) - 356 patients. Before the procedure was finished, all patients underwent optical coherence tomography (OCT) analysis. Regardless of its results no more adjacent procedures were performed.

Results: we provide characteristics of patients included in this study These characteristics showed an absence of significant differences between two groups of patients (IVUS and QCA groups) and between subgroups of patients, received different types of DES. While analyzing parameters of index procedure, it was emphasized that IVUS group involved a bigger number of patients with left main disease and bifurcation disease, and also a bigger number of stents per lesion, diameter of first stent, total length of used stents, maximal diameter of the postdilatation balloon. Characteristics of Nobori stent (range of sizes) can explain that significantly smaller diameter and length of the first and the second stent implanted, total length of stents per lesion, and maximal diameter of postdilatation balloon were recorded in the Nobori stent subgroup of patients. Besides that, in that subgroup were no patients with left main disease, smaller number of patients with angiographically evident calcifications, but was a bigger number of patients with circumflex artery disease. Immediate effect of the implantation was obtained in 100% of patients. According to the short-term follow-up, 1 patient died due to the myocardial infarction in the region of the untreated artery

Conclusion: angiographic data, and IVUS and OCT results of analyzed patients are going to be published in the next article.  

References 

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Abstract:

Aim: was to analyze long-term results of coronary artery stenting with drug-eluting stents «Zotarolimus» and bare metal stents in patients with a concomitant diabetes mellitus type II.

Materials and methods: 37 patients with ischemic heart disease and concomitant diabetes mellitus type II were selected for analysis; they underwent implantation of stents without drug coverage («Intergrity» «Medtronic») or stents with drug-eluting «Zotarolimus» («Resolute Integrity» «Medtronic»). All patients were divided into 2 groups: first group consisted of 11 patients, who underwent implantation of bare metal stents, second group - 26 patients who underwent implantation of drug-eluting stents, «Zotarolimus». Follow-up period was 26±4 months. Criteria of stenting efficiency were: angiographic assessment of coronary arteries anatomy in control angiography after stent implantation, reccurence of angina or functional class increase, the survival rate in the nearest postoperative period, before discharge, but not more than 30 days, and in the early post-operative period up to 6 months. In the medium-distant post-operative period - 12 months, and in the late postoperative period - 24 months.

Results: all patients underwent successfully performed endovascular revascularization. The optimal angiographic result was achieved in all patients. Regression of ischemic changes on ECG data and increase myocardial contractility by echocardiography data also were marked in all patients. In long-term follow-up period, in 5 (45%) patients with bare metal stents we noted the appearence of hemodynamically significant restenosis, that needed performance of secondary angioplasty with stenting.

Conclusion: the use of antiproliferative drug-eluting stents «Zotarolimus» is possible in treatment of patients with coronary artery disease and comorbid diagnosis of diabetes mellitus type II. Bare metal stents in coronary stenting in patients with concomitant diagnosis of diabetes mellitus type II is impractical due to developing in-stent restenosis (45% of patients). 

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