Optical coherence tomography analysis of neointimal tissue in drug-eluting stents with biodegradable and durable polymer coatings: the ALSTER-OCT registry

Christian-Hendrik Heeger, Felix Lesche, Maximillian Fenski, Laura Hildebrand, Robert A. Byrne, Anne-Sophie Schedifka, Alexander Ghanem, Tomohisa Tada, Felix Meincke, Andreas Busjahn, Peter Wohlmuth, Michael Joner, Karl-Heinz Kuck, Martin W. Bergmann

Aims: Optical coherence tomography (OCT) for follow-up after drug-eluting stent implantation permits detection of strut coverage, apposition and neointimal tissue. We aimed to compare OCT follow-up data and clinical outcome of two new-generation drug-eluting stents, Orsiro sirolimus-eluting stents (O-SES) and zotarolimus-eluting stents (ZES).

Methods and results:
Eighty patients underwent OCT following implantation of O-SES (n=34) or ZES (n=46). Imaging was performed after three (n=39), six (n=28) or nine months (n=13). OCT data were acquired (coverage, apposition, neointimal thickness) and neointimal maturation was assessed by novel greyscale signal intensity analysis. Image analysis revealed increased strut coverage, tissue maturation and neointima formation over the three time points. There were no significant differences between O-SES and ZES in terms of coverage and apposition at any time. We also found no differences for neointimal thickness, maturation and rate of major adverse cardiac events (a composite of cardiac death, myocardial infarction and ischaemia-driven target lesion revascularisation within 12 months, O-SES 9.4% vs. ZES 6.8%, p=0.69).

No statistical differences were observed between O-SES and ZES concerning stent healing as well as one-year clinical outcome. Although preliminary, our findings may support the hypothesis that OCT-based analyses in small patient cohorts sensitively detect stent healing and could possibly be regarded as surrogates for DES healing and closely correlated to clinical outcome.

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