Abstract 12197: Detailed Investigation of Vascular Response between Patients with or without Diabetes Mellitus after Everolimus-eluting Stent Implantation; Optical Coherence Tomography Study
Background: Previous reports have shown potential disadvantage of limus derivative drugs for the treatment of patients with diabetes mellitus (DM). Everolimus-eluting stent (EES) is a second generation drug-eluting stents with biocompatible polymer covering thinner stent strut. Therefore, the impact of DM on vessel healing might be minimum.
Method: We prospectively enrolled 122 de novo coronary artery lesions (DM: n=52, non-DM: n=70) in 85 patients treated with EES and performed scheduled 10-month follow-up angio with optical coherence tomography (OCT) regardless of symptoms. To investigate a potential baseline difference between DM and non-DM lesions, pre interventional IVUS were also evaluated. In addition to standard OCT variables, variability of neointima thickness (NIT) was evaluated by standard deviation o fNIT computed from 360 equally-spaced radial sectors along the entire segment for the assessment of uniformity of neointima suppression. Additionally, the incidence of struts with peri-strut low intensity area (%PLIA), suggestive of fibrin deposition or impaired neointima maturation, was calculated.
Result: Pre interventional IVUS showed that the % plaque volume in DM was significantly larger than that in non-DM. Follow up OCT revealed that the average NIT and neointima coverage didn't differ between DM and non-DM (Table). DM had, however, a greater asymmetric stent expansion and variability of NIT than non-DM (Table). There was a weak, but significant association between average stent eccentricity index and neointima variability score (P=0.01), which might be caused by large plaque volume in DM. The prevalence of PLIA and thrombus didn't differ between the groups.
Conclusion: Although EES provided similar neointima thickness and coverage regardless of DM, uneven neointima suppression was observed in DM. A larger plaque volume of culprit lesion may hamper symmetric stent expansion, possibly explaining nonuniform neintima suppression in DM.
- Drug eluting stents
- Type 2 Diabetes
- Coronary artery disease
- Intravascular ultrasound/Doppler
- Interventional cardiology
- © 2012 by American Heart Association, Inc.