SONG XIANTAO MD Beijing Anzhen Hospital affiliated to Capital Medical University

 One of the best morphologic predictors of stent thrombosis is thought to be the extent of uncovered stent strut surfaces in human autopsy studies.  Clinical assessment of neointimal coverage over stent struts has emerged as a potential avenue for assessing the risk of SES thrombosis.  OCT can be used to examine changes in neointimal thickness and stent apposition to the vessel wall in precise detail. Finn AV, et al. Circulation 2007;115: Awata M, et al. Circulation 2007;116:

Neointimal coverage of SES 3 months after implantation Masamichi Takano, et al. Am J Cardiol 2007;99:

Neointimal coverage of SES 3 months after implantation  21 lesion 31 SESs  4516 strut in 567-mm single stent segment  NIH: 29  41  m  NIH area: 10  4%  Exposed struts:15%  Exposed struts with malapposition: 6%  NIH  100  m: 7%  85% of struts surrounding NIH by OCT Masamichi Takano, et al. Am J Cardiol 2007;99:

Neointimal coverage of SES 6 months after implantation  34 patients 57 SESs  NIH: 52.5  m (28.0,147.6)  9 SES (16%) showed full coverage by neointima.  89% had well-apposed struts with neointima  8% well-apposed struts without neointima  2% malapposed struts without neointima  1% a side branch site Daisuke Matsumoto, et al. Euro Heart J 2007;28:

Neointima coverage patterns  1 well-apposed to vessel wall with neointima  2 well-apposed without neointima  3 malapposed with neointima  4 malapposed without neointima  5 side branch orifice with neointima  6 side branch orifice without neointima Hiroki Katoh, et al Circ J 2009

13 patients 21 SESs; 2321 struts at 6 months and 2285 struts at 12 months Hiroki Katoh, et al Circ J 2009 At 6 months At 12 months Struts without neointimal coverage 10.4%5.7% Malapposed struts1.7%0.2% average NIH 112  123  m 120  13 0  m Struts located at side branch orifice without neointima 24%0 Complete coverage with neointima 14%24%

 Distribution of neointimal thickness on SES struts at 6 months and 12 months.  There was no remarkable shift in the thickness distribution between 6 months and 12 months, but the frequency of neointimal thickness greater than 100  m was increased. Hiroki Katoh, et al Circ J 2009

Ken0ichi Ishigami, et al. Circ J 2009;73:

Neointima coverage after different DES implantation AuthorsDESTimeNIHExposed struts Naoki Myioshi, et al PES vs. SES6 months 90  m vs. 50  m Well-apposed struts with neointima: 92.6% vs. 85.8% Jin –Sun Kim PES vs.SES9 months 4.9  7.9% vs  15.2% J S KimZES vs. SES9 months  m vs.85.5  m 0.3% vs. 12.3% BX ChenBMS vs. SES Feng TianSES overlap

Helios SES  Manufactured by taking Co-Cr alloy (L605) tube as the basic material and pre-installed in a balloon catheter after plating Ti-O.  The drug layer is composed of a drug carrier, poly- D L-lactic-co-glycolic acid (PLGA), and an immune inhibitor drug known as rapamycin.

Helios SES  A. Neointimal coverage: coverage thickness ≥10μm.  B. Delayed vascular neointimal coverage: coverage thickness of the strut < 10μm.  C. Incomplete stent apposition (ISA) with delayed neointimal coverage.  D.ISA with neointimal coverage.  ISA was defined as a distance from the medial midpoint of the stent shadow to the vascular luminal surface was ≥110µm

Helios SES  10 case, 296-mm length (2,063 struts)  9 months  All patients had delayed neointima coverage and ISA  The average neointima area percentage was ±5.6625%, while the average neointima area of type A was ± %.  NIH: 40  m

Summary  Neointima coverage (NIH)  Catch up?  Should the low rate of neointima coverage lead us to prolong the dual antiplatelet therapy?  Fibrin deposition ? Thin endothelia ?  LSM/Aneurysm

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