Relative dose and vascular response after drug-eluting stent implantation: A dosimetric 3D-intravascular ultrasound study

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• 作者：Hideki Kitahara ; Katsuhisa Waseda ; Ryotaro Yamada ; Kenji Sakamoto ; Paul G. Yock ; Peter J. Fitzgerald ; Yasuhiro Honda ; ^{crci-cvmed@stanford.edu" class="auth_mail" title="E-mail the corresponding author}
• 关键词：Drug-eluting stent ; Intravascular ultrasound ; Coronary artery disease
• 刊名：International Journal of Cardiology
• 出版年：2016
• 出版时间：1 February 2016
• 年：2016
• 卷：204
• 期：Complete
• 页码：211-217
• 全文大小：646 K

文摘

In drug-eluting stents (DESs), the theoretical drug dose exposed to the vessel wall per stent surface area may vary due to the fixed loading dose and differences in the stent surface area once expanded in varying vessel sizes. The aim of this study was to evaluate the potential effects of different dose intensities, as estimated by 3D-IVUS dosimetry, on vascular response after DES implantation.

Methods

Follow-up (6–9 months) 3D-IVUS was performed in 840 coronary lesions treated with a single DES of the following types: sirolimus (SES, n = 148), paclitaxel (PES, n = 162), Endeavor zotarolimus (E-ZES, n = 233), Resolute zotarolimus (R-ZES, n = 147), and everolimus (EES, n = 150). Volume index (volume/length, mm³/mm) was obtained for vessel, lumen, plaque, stent, and neointima. In each lesion, exposed dose intensity was calculated as known loading dose divided by measured luminal surface area of the stented segment. Lesions were divided into tertiles based on the exposed dose intensity: high, medium, and low dose groups.

Results

The exposed dose intensity ranged 0.74–1.76 μg/mm² for SES, 0.41–1.18 μg/mm² for PES, 0.71–1.57 μg/mm² for E-ZES, 0.72–1.63 μg/mm² for R-ZES, and 0.40–0.99 μg/mm² for EES. All types of DES showed no significant difference in neointimal hyperplasia among the 3 groups, except that E-ZES showed significantly less neointimal hyperplasia in the high dose group.

Conclusions

Detailed 3D-IVUS revealed significant lesion-to-lesion variability in dose intensity exposed to the vessel wall following DES implantation. However, the major types of DES appear to yield equally effective neointimal suppression, despite the varying dose intensity, except for E-ZES.