Vascular Responses in Patients With and Without Diabetes Mellitus After Everolimus-Eluting Stent Implantation – Optical Coherence Tomography Study –

Masamichi Iwasaki; Hiromasa Otake; Toshiro Shinke; Masayuki Nakagawa; Hirotoshi Hariki; Tsuyoshi Osue; Takumi Inoue; Yu Taniguchi; Ryo Nishio; Hiroto Kinutani; Akihide Konishi; Noritoshi Hiranuma; Masaru Kuroda; Junya Shite; Ken-ichi Hirata

doi:10.1253/circj.CJ-13-1540

Cardiovascular Intervention

Vascular Responses in Patients With and Without Diabetes Mellitus After Everolimus-Eluting Stent Implantation

– Optical Coherence Tomography Study –

Masamichi Iwasaki, Hiromasa Otake, Toshiro Shinke, Masayuki Nakagawa, Hirotoshi Hariki, Tsuyoshi Osue, Takumi Inoue, Yu Taniguchi, Ryo Nishio, Hiroto Kinutani, Akihide Konishi, Noritoshi Hiranuma, Masaru Kuroda, Junya Shite, Ken-ichi Hirata

Author information

Masamichi Iwasaki
Division of Cardiovascular and Respiratory Medicine, Department of Internal Medicine, Kobe University Graduate School of Medicine
Hiromasa Otake
Division of Cardiovascular and Respiratory Medicine, Department of Internal Medicine, Kobe University Graduate School of Medicine
Toshiro Shinke
Division of Cardiovascular and Respiratory Medicine, Department of Internal Medicine, Kobe University Graduate School of Medicine
Masayuki Nakagawa
Division of Cardiovascular and Respiratory Medicine, Department of Internal Medicine, Kobe University Graduate School of Medicine
Hirotoshi Hariki
Division of Cardiovascular and Respiratory Medicine, Department of Internal Medicine, Kobe University Graduate School of Medicine
Tsuyoshi Osue
Division of Cardiovascular and Respiratory Medicine, Department of Internal Medicine, Kobe University Graduate School of Medicine
Takumi Inoue
Division of Cardiovascular and Respiratory Medicine, Department of Internal Medicine, Kobe University Graduate School of Medicine
Yu Taniguchi
Division of Cardiovascular and Respiratory Medicine, Department of Internal Medicine, Kobe University Graduate School of Medicine
Ryo Nishio
Division of Cardiovascular and Respiratory Medicine, Department of Internal Medicine, Kobe University Graduate School of Medicine
Hiroto Kinutani
Division of Cardiovascular and Respiratory Medicine, Department of Internal Medicine, Kobe University Graduate School of Medicine
Akihide Konishi
Division of Cardiovascular and Respiratory Medicine, Department of Internal Medicine, Kobe University Graduate School of Medicine
Noritoshi Hiranuma
Division of Cardiovascular and Respiratory Medicine, Department of Internal Medicine, Kobe University Graduate School of Medicine
Masaru Kuroda
Division of Cardiovascular and Respiratory Medicine, Department of Internal Medicine, Kobe University Graduate School of Medicine
Junya Shite
Division of Cardiovascular and Respiratory Medicine, Department of Internal Medicine, Kobe University Graduate School of Medicine
Ken-ichi Hirata
Division of Cardiovascular and Respiratory Medicine, Department of Internal Medicine, Kobe University Graduate School of Medicine

Keywords: Everolimus-eluting stents, Diabetes mellitus, Optical coherence tomography

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Supplementary material

2014 Volume 78 Issue 9 Pages 2188-2196

DOI https://doi.org/10.1253/circj.CJ-13-1540

Editorial (78-9 pp.2149-2150)

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Abstract

Background:Previous reports have shown potential disadvantages of limus-derivative drugs for the stenting treatment of patients with diabetes mellitus (DM).Methods and Results:We studied 159 coronary artery lesions (DM: n=72, non-DM: n=87) in 123 patients treated with everolimus-eluting stent (EES) and who underwent scheduled 9-month follow-up angiography with optical coherence tomography (OCT) regardless of symptoms. In addition to standard OCT variables, neointimal unevenness score (maximum/average neointimal thickness) and stent eccentricity index (minimum/maximum stent diameter) were calculated for each cross-section. To investigate a potential baseline difference between DM and non-DM lesions, pre- and post-interventional intravascular ultrasound (IVUS) images were also evaluated as an IVUS subgroup analysis. The average neointimal thickness and neointimal coverage did not differ between DM and non-DM patients. DM patients had, however, greater asymmetric stent expansion and variability of neointimal thickness than non-DM patients. There was a weak, but significant association between average stent eccentricity index and neointimal unevenness score. The IVUS substudy showed that the culprit plaque volume and plaque eccentricity in DM patients were significantly greater than in non-DM patients.Conclusions:Although EES provided a similar level of average neointimal thickness and coverage both in the presence and absence of DM, uneven neointimal suppression occurred in DM patients. A larger plaque volume of the culprit lesion may hamper symmetric stent expansion, possibly explaining the non-uniform neointimal suppression in DM patients. (Circ J2014;78:2188–2196)

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