Continuous neointimal hyperplasia formation after five years ofdifferent generations of DES: is there enough evidence of late‘catch-up’?

ABSTRACT

Aims: The amount of neointimal hyperplasia (IH) following drug-eluting stent (DES)implantation correlates with the potency of the anti-proliferative drug, its kineticrelease as well as some individual characteristics, as the presence of diabetesmellitus (DM). Recently, some publications have suggested a continuous growth ofIH following DES, which in some cases, might result in late “catch-up”. The aim ofthis study was to assess, by means of serial intravascular ultrasound (IVUS) thetemporal course of IH formation following the implantation of two differentgeneration of DES (durable-polymer sirolimus-eluting stent [SES] andbiodegradable-polymer biolimus-eluting stent [BES]); and the role of diabetesmellitus in this scenario.Methods and results: Patients included in this study represent our single centerinitial experience with SES and BES. Twenty-five pts with single de novo lesions innative coronary arteries, with reference vessel diameter between 2.5 and 3.5 mmwere treated with Cypher-SES (n=12) and Biomatrix-BES (n=13), and underwentIVUS evaluation post procedure, at a mean of 9 months and 5 years. We onlyincluded patients with at least three serial IVUS acquisitions (post procedure, midand very long-term). Comparisons between baseline, first and second follow-up(FU) were done using the Friedman test and comparison between early and lateFU were done using the Wilcoxon test. The mean age was 59 years, with 28% ofDM. Stable coronary syndrome was the initial clinical indication for the majority ofthe cases (88%). Baseline characteristics did not differ between the groups.Overall, percentage of IH obstruction and IH volume markedly increased from midto long-term FU (percentage IH obstruction of 1.3% at 1st FU vs. 4.8% 2nd FU...