Abstract 1717: Post-Procedural Incomplete Stent Apposition after Implantation of Everolimus-Eluting or Paclitaxel-Eluting Stents: Insights from the Randomized SPIRIT III Trial
Background: We investigated the morphometric changes of post-procedural incomplete stent apposition (ISA) after implantation of Everolimus-eluting cobalt-chromium alloy XIENCE™ V stents (EES) and Paclitaxel-eluting Taxus™ stents (PES).
Methods: Data were obtained from the SPIRIT III trial (2:1 randomized, multicenter trial comparing EES to PES in de novo native coronary artery lesions). Serial IVUS imaging was performed post-intervention and at 8 months follow-up. ISA was defined as separation of at least 1 stent strut from the vessel wall with evidence of blood speckle behind the strut. The following parameters were obtained from the IVUS analysis:
ISA area at the maximum ISA (max ISA) site, ISA angle (angle of the ISA arc at the max ISA site), ISA depth (length between the stent strut and the vessel wall at the max ISA site), and ISA length (longitudinal length of the ISA);
vessel, stent, lumen, peri-stent plaque, and neointimal hyperplasia area at the ISA site.
Results: At baseline, there were 34 ISA sites in 29 EES (18 at the proximal edge, 9 at the distal edge, and 7 within the stent body), and 16 ISA sites in 11 PES (4 at the proximal edge, 5 at the distal edge, and 7 within the stent body). ISA area, angle, depth, and length decreased between post-procedure and follow-up period in both groups (Table⇓). Vessel and peri-stent plaque area increased in PES, whereas no changes were observed in EES. There was no difference in the incidence of either persistent or resolved ISA between the 2 groups (p=0.32). Neither stent thrombosis nor in-stent restenosis occurred in the patients with post-procedural ISA over a period of 12 months.
Conclusion: This IVUS analysis suggests different vessel responses at the site of post-procedural ISA between EES and PES, but no clinical consequences. Longer term follow-up with larger cohorts is warranted to further validate the clinical implications of ISA with drug-eluting stents.