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Neoatherosclerosis observed more frequently with drug-eluting stents
Nakazawa G. J Am Coll Cardiol. 2011;57:1314-1322.
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Despite occurring with both drug-eluting stent and bare metal stent usage, neoatherosclerosis was observed more frequently and earlier in those given a drug-eluting stent, study data indicated.
“To our knowledge, the present study represents the first report demonstrating the incidence and type of neoatherosclerosis within [drug-eluting stents] and [bare metal stents] from a large series of stents implanted in native human coronary arteries,” the researchers wrote. “Because only histologic studies can provide sufficient detail to accurately characterize neoatherosclerosis within stents, our results offer important insights into late cardiac events attributed to stents.”
In the study, the Maryland- and Atlanta-based researchers utilized all available cases from the CVPath stent registry, which included 299 autopsy cases that had implant duration of more than 30 days. The cases featured 406 total lesions, which were split between those given bare metal stents (n=197) and those given drug-eluting stents (n=209). The drug-eluting stents used in the study were sirolimus-eluting (Cypher, Cordis Corp.) and paclitaxel-eluting (Taxus, Boston Scientific) stents.
Overall, incidence of neoatherosclerosis, or neointimal atherosclerotic change, was higher in the drug-eluting stents lesions (31% vs. 16%; P<.001), with a much shorter median stent duration reported in those treated with drug-eluting stents who had neoatherosclerosis (420 days vs. 2,160 days; P<.001).
Furthermore, unstable lesions — characterized as thin-cap fibroatheromas or plaque rupture — were more frequent in bare metal stents (4% vs. 1%;), but not to a statistically significant extent. In bare metal stents, most of these lesions were seen in stents implanted more than 5 years earlier, whereas in drug-eluting stents, they were generally reported in those implanted less than 2 years before.
After multiple logistic regression analysis, independent factors of neoatherosclerosis included younger age (P<.001), sirolimus-eluting (P<.001) and paclitaxel-eluting (P=.001) stent usage, longer implant duration (P<.001) and underlying unstable plaques (P=.004).
These observations, the researchers concluded, “suggest that neoatherosclerosis could be accelerated in [drug-eluting stents], and in rare cases, contribute to very late thrombotic events in both [bare metal stents] and [drug-eluting stents].”
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