Differences in optical coherence tomography findings between an endothelial progenitor cell-capture sirolimuseluting stent and a paclitaxel-eluting stent: insights from the OCT substudy of the REMEDEE first-in-man trial

Stephen W.L. Lee, Michael Haude, Akiko Maehara, Shun-Ling Kong, Hubertus Degen, Roxana Mehran

Abstract
Aims: First-generation DES are associated with delayed endothelial coverage and poor stent healing, increasing the risk of late stent thrombosis, late catch-up and neoatherosclerosis. This observational REMEDEE substudy aimed to examine differences in vascular healing by OCT between the EPC-capture sirolimus-eluting COMBO stent and a paclitaxel-eluting stent (TAXUS).


Methods and results:
A subset of 33 patients (COMBO=23, TAXUS=10) with de novo coronary artery lesions in the REMEDEE study had OCT examination at the nine-month angiographic follow-up. Betweenstent differences of OCT strut coverage, apposition, and neointimal morphology were compared by a core laboratory. Four thousand eight hundred and seventy-five COMBO and 2,697 TAXUS stent struts were analysed. More COMBO (98.5%) than TAXUS (97.6%) struts were well apposed and covered (p=0.3998); when overlying the ostium of a side branch, more TAXUS (0.7%) than COMBO (0.2%) struts were uncovered (p=0.0135). The COMBO stent was associated with a more homogeneous neointimal pattern (79.2% vs. 40.0% for TAXUS, p=0.04) and less layering (0.0% vs. 20.0% with TAXUS, p=0.08).


Conclusions:
OCT showed nearly complete (98.5%) coverage of the COMBO stent by nine months and significantly more homogeneous neointimal tissue than with the TAXUS. These observations suggest better healing with the COMBO stent in comparison with the TAXUS stent at nine months.

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