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Click to edit Master title style,Click to edit Master text styles,Second level,Third level,Fourth level,Fifth level,Click to edit Master title style,Click to edit Master text styles,Second level,Third level,Fourth level,Fifth level,Angioscopic Findings of Neointimal Coverage after Drug Eluting Stent Implantation,Shinsuke Nanto,M.D.,PhD.,Department of Advanced Cardiovascular Therapeutics,Osaka University Graduate School of Medicine,Late thrombosis in drug-eluting coronary stents after discontinuation of antiplatelet therapy,McFadden EP,Serryus PW et al.Lancet 2004,On 442 days of DES implantation,the patient developed AMI one week after aspirin was discontinued because of surgical therapy of colon carcinoma.,Pre procedure,Stent implantation,Post procedure,Late stent thrombosis,Factors of Stent Thrombosis,Coronary blood flow,Multiple stenting,Procedure Related Factors,Morphometric abnormalities,(Underexpansion,Asymmetry?),Molphologic abnormalities,(Dissection,Incomplete apposition,Thrombus,Tissue protrusion),Mechanical vessel injury,Anti-thrombotic therapy,Biocompatibility,Patient/Lesion factors,Vessel size,Lesion length,Acute coronary syndrome,Plaque characteristics,Local plt/coagulation activity,Left ventricular function,Resistance for drugs,Stent Thrombogenisity,Material,Designs,Surface coating,Adjunctive therapeutic agents,(drug,Radiation),Honda Y and Fitzgerald PJ.Circulation 2003;108.,Angioscopic Findings of Neointimal Coverage after Drug Eluting Stent Implantation,Coronary angioscply,Vecmova NEO,(FiberTech,Tokyo,Japan),Classification of Angioscopic Findings,Grade 0,Grade 1,Grade 2,Grade,Grade 0,:struts were exposed similarly to the time of implantation,Grade 1,:struts were covered,but not embedded,Grade 2,:struts were embedded by the neo-intima,but translucency seen,Grade 3,:struts were fully embedded and invisible by angioscopy,Kotani J,Awata M,Nanto S,et al.JACC.2006,Neointimal Coverage Grades,3 to 6 Months After Stent Implantation,0,25,50,75,100,Bare-Metal Stent(n=22),(%),100,75,50,25,0,Incomplete coverage,Sirolimus-Eluting Stent(n=15),Complete coverage,Grade 3,Grade 2,Grade 1,Grade 0,Kotani J,Awata M,Nanto S,et,al.JACC.2006,Representative Cases:BMS vs.SES,Bare-metal stent(BMS)Sirolimus-eluting stent(SES),(Grade 3)(Grade 1),Stent:Cypher 3.518mm,Location:RCA mid,3.7 months f-up,Stent:Bx Velocity 3.523mm,Location:LAD mid,2.7 months f-up,A Case implanted both BMS and DES,Follow up 3.7 months,Bx,Verocity 3.0,18,59 y.o.female,Cypher 3.5,18,12 months,24 months,months,Changes in Neointimal Coverage Grade,Awata M,Kotani J,Nanto S et al.Circulation.2007,Comparison of Angioscopic FindingsSES versus PES at 8 Months,Thirty,PES,were angioscopically compared with 36,SES,.,Intra-and inter-stent heterogeneinty of neointimal coverage were more common in PES.,Incidence of thrombi and yellow plaques were similar between the two groups.,Awata M,Nanto S et al.JACC Cardiol Intv 2009,Neointimal Coverage Grades at 8 months,PES(n=30),SES(n=36),Grade 0,Grade 1,Grade 2,Grade 3,PES vs.SES:p=0.002 by,2,test,test,(%),Awata M,Nanto S et al.JACC Cardiol Intv,2009,Homogeneous,Heterogeneity of Neointimal Coverage Grades,Awata M,Nanto S et al.JACC Cardiol Intv 2009,PES vs.SES:p=0.0006 by,2,test,Heterogeneity,of 1 grade,PES,(n=30),SES,(n=36),Heterogeneous,53%,47%,26%,48%,26%,Homogeneity,Heterogeneity,of 2 grade,74%,Comparison of Angioscopic FindingsSES versus ZES at 8 Months,Awata M,Nanto,S,et al.JACC.2008,Cypher 3.523mm,Endeavor 3.523mm,Neointimal,Coverage,Grades,at 8 months,(%),Awata M,Nanto S,et al.JACC.2008,In-stent ate loss,-SES=0.07 0.18mm,-ZES=0.51 0.17mm,（,p0.0001,）,Incidence of Thrombi and Yellow plaques,(n=14),(n=16),P=0.2,(n=14),(n=16),P=0.004,Thrombi,Yellow plaques,Angioscopic Findings ZES vs.SES,8 mo.after implantation,11 mo.after implantation,Results of ENDEAVOR-III,Patient Frequency Distributions,of In-segment Late Loss,0.13,0.32,0.34,0.44,Results of ENDEAVOR-III,Patient Frequency Distributions,of In-segment Late Loss,0.13,0.32,0.34,0.44,The Ideal DES Should Have,Optimal Late Loss with Narrow Distributions,0.13,0.32,0.34,0.44,Ideal DES,Summary,Angiographic findings of DES revealed,Prolonged delayed growth of neointima,Poor but homogenous covering over SES,Heterogeneous luminal surface of PES,White and homogenous appearance in patients treated with ZES:,Basically grade 3 neoinitma,A few yellow plaques and thrombi,Take Home Massages,New Concept for Next-generation DES,Considering the risk of stent thrombosis due to incomplete neointimal coverage,it is preferable for DES to have sufficient neointimal volume with homogeneous coverage.,Optimal late loss with homogeneous coverage,may be desirable for adequate,endothelial,healing following stenting.,
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