Volume 61, Issue 1, Pages (January 2013)

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Volume 61, Issue 1, Pages 22-30 (January 2013) Coronary angioscopic findings 9 months after everolimus-eluting stent implantation compared with sirolimus-eluting stents Kazuoki Dai, MD, Masaharu Ishihara, MD, PhD, FACC, FJCC, Ichiro Inoue, MD, PhD, Takuji Kawagoe, MD, PhD, FJCC, Yuji Shimatani, MD, Fumiharu Miura, MD, PhD, Yasuharu Nakama, MD, Takayuki Otani, MD, Kuniomi Ooi, MD, Hiroki Ikenaga, MD, Masayuki Nakamura, MD, Takashi Miki, MD, Shinji Kishimoto, MD, Yoji Sumimoto, MD Journal of Cardiology Volume 61, Issue 1, Pages 22-30 (January 2013) DOI: 10.1016/j.jjcc.2012.08.011 Copyright © 2012 Japanese College of Cardiology Terms and Conditions

Fig. 1 Angioscopic grading of neointimal stent strut coverage. Grade 0: stent struts with complete exposure (similar to immediately after implantation). Grade 1: transparent stent struts with dull light reflexion. Grade 2: stent struts slightly visible, with no light reflexion from stent struts. Grade 3: stent struts were completely covered, and not seen through neointima. Journal of Cardiology 2013 61, 22-30DOI: (10.1016/j.jjcc.2012.08.011) Copyright © 2012 Japanese College of Cardiology Terms and Conditions

Fig. 2 Grading of yellow plaque. The color of the plaques was graded as 0 (white), 1 (light yellow), 2 (yellow), 3 (bright yellow). Journal of Cardiology 2013 61, 22-30DOI: (10.1016/j.jjcc.2012.08.011) Copyright © 2012 Japanese College of Cardiology Terms and Conditions

Fig. 3 Distribution of neointimal coverage (all patients). Among all patients, there was no significant difference in minimum (p=0.21), maximum (p=0.21), or dominant grade (p=0.74) of neointimal coverage, and heterogeneity index (p=0.19) between everolimus-eluting stents (EES) and sirolimus-eluting stents (SES). Journal of Cardiology 2013 61, 22-30DOI: (10.1016/j.jjcc.2012.08.011) Copyright © 2012 Japanese College of Cardiology Terms and Conditions

Fig. 4 Distribution of neointimal coverage [acute coronary syndrome (ACS) group]. Among ACS group, there was no significant difference in minimum (p=0.26), maximum (p=0.84), or dominant grade (p=0.82) of neointimal coverage, and heterogeneity index (p=0.75) between everolimus-eluting stents (EES) and sirolimus-eluting stents (SES). Journal of Cardiology 2013 61, 22-30DOI: (10.1016/j.jjcc.2012.08.011) Copyright © 2012 Japanese College of Cardiology Terms and Conditions

Fig. 5 Distribution of neointimal coverage [stable angina pectoris (SAP) group]. Among the SAP group, maximum grade and heterogeneity index were less advanced in everolimus-eluting stents (EES) than sirolimus-eluting stents (SES) (p<0.05). Journal of Cardiology 2013 61, 22-30DOI: (10.1016/j.jjcc.2012.08.011) Copyright © 2012 Japanese College of Cardiology Terms and Conditions

Fig. 6 Maximum color grade of the plaques. Maximum color grade of the plaques was less advanced in everolimus-eluting stents (EES) than sirolimus-eluting stents (SES) (p<0.01). Yellow plaques of grade 2 or 3 were less frequent in EES than SES (35% vs 76%, p<0.01). Maximum color grade of the plaques tended to be less advanced in EES than SES in both acute coronary syndrome (ACS) group and stable angina pectoris (SAP) group (Fig. 6). Journal of Cardiology 2013 61, 22-30DOI: (10.1016/j.jjcc.2012.08.011) Copyright © 2012 Japanese College of Cardiology Terms and Conditions

Fig. 7 Incidence of thrombus formation. Thrombus was less frequently observed in everolimus-eluting stents (EES) than sirolimus-eluting stents (SES) (4% vs 29%, p=0.02) among all patients. Among 41 patients with SES, 12 patients (29%) were found to have thrombus: red thrombus in 8 patients, white thrombus in 2 patients, and both thrombus in 2 patients. Among 23 patients with EES, only 1 patient (4%) was found to have red thrombus. There was a tendency toward less thrombus in EES than SES, in both the acute coronary syndrome (ACS) group (0% vs 35%, p=0.07) and the stable angina pectoris (SAP) group (7% vs 22%, p=0.35). Journal of Cardiology 2013 61, 22-30DOI: (10.1016/j.jjcc.2012.08.011) Copyright © 2012 Japanese College of Cardiology Terms and Conditions

Fig. 8 Representative cases: angioscopic findings 8 months after everolimus-eluting stent implantation in a patient with acute myocardial infarction and 1 year after sirolimus-eluting stent implantation in a patient with acute myocardial infarction. (A) A 62-year-old man with acute myocardial infarction was treated with everolimus-eluting stent (3.0×15mm) implantation in the proximal left circumflex artery. Eight months after stent implantation, coronary angiography showed no restenosis. Coronary angioscopic images were shown above. Neointimal coverage was graded as grade 0 at the proximal and distal portion and grade 1 at the mid portion of the stent. Color grade of the plaques was graded as grade 0. (B) A 72-year-old man with acute myocardial infarction was treated with sirolimus-eluting stent (3.5×18mm) implantation in the proximal left anterior descending artery. One year after stent implantation, coronary angiography showed no restenosis. Coronary angioscopic images were shown above. At the proximal portion of the stent, neointimal coverage was graded as grade 0. Red thrombus was adhered to the stent strut. At the mid portion of the stent, neointimal coverage was grade 1, and white thrombus was observed adhered on the yellow plaques. At the distal portion, neointimal coverage was graded as grade 2. Journal of Cardiology 2013 61, 22-30DOI: (10.1016/j.jjcc.2012.08.011) Copyright © 2012 Japanese College of Cardiology Terms and Conditions