Assessment of Vascular Patency and Inflammation with Intravascular Optical Coherence Tomography in Patients with Superficial Femoral Artery Disease Treated with Zilver PTX Stents
- PMID: 31395436
- DOI: 10.1016/j.carrev.2019.07.009
Assessment of Vascular Patency and Inflammation with Intravascular Optical Coherence Tomography in Patients with Superficial Femoral Artery Disease Treated with Zilver PTX Stents
Abstract
Purpose: Zilver PTX nitinol self-expanding drug-eluting stent with paclitaxel coating is effective for treatment of superficial femoral artery (SFA) disease. However, as with any stent, it induces a measure of vascular inflammatory response. The current clinical trial (NCT02734836) aimed to assess vascular patency, remodeling, and inflammatory markers with intravascular optical coherence tomography (OCT) in patients with SFA disease treated with Zilver PTX stents.
Methods: Serial OCT examinations were performed in 13 patients at baseline and 12-month follow-up. Variables evaluated included neointimal area, luminal narrowing, thrombus area, stent expansion as well as measures of inflammation including, peri-strut low-intensity area (PLIA), macrophage arc, neovascularization, stent strut apposition and coverage.
Results: Percentage of malapposed struts decreased from 10.3 ± 7.9% post-intervention to 1.1 ± 2.2% at 12-month follow-up, but one patient showed late-acquired stent malapposition (LASM). The percent of uncovered struts at follow-up was 3.0 ± 4.5%. Average expansion of stent cross-sectional area from baseline to follow-up was 35 ± 19%. The average neointimal area was 7.8 ± 3.8 mm2. Maximal luminal narrowing was 61.1 ± 25.0%, and average luminal narrowing was 35.4 ± 18.2%. Average peri-strut low-intensity area (PLIA) per strut was 0.017 ± 0.018 mm2. Average number of neovessels per mm of stent was 0.138 ± 0.181. Average macrophage angle per frame at follow-up was 7 ± 11°. Average thrombus area at follow-up was 0.0093 ± 0.0184 mm2.
Conclusion: At 12-month follow-up, OCT analysis of Zilver PTX stent shows outward remodeling and minimal neointimal growth, but evidence of inflammation including PLIA, neovessels, thrombus and macrophages.
Summary: Thirteen patients with PAD had paclitaxel-coated stents implanted in their SFAs and were then imaged with OCT at baseline and 12-month follow-up. OCT proxy metrics of inflammation were quantified.
Keywords: IVOCT; Inflammation; Paclitaxel-coated stent; Zilver PTX.
Copyright © 2019 Elsevier Inc. All rights reserved.
Conflict of interest statement
Declaration of Competing Interest Marc Feldman, Thomas Milner, and Taylor Hoyt have received salary support from the Clayton Foundation for Research. This work was supported by grants from the Clayton Foundation for Research and Cook Medical. Neither funder had any role in study design, data collection, analysis, or interpretation, report writing, or the decision to submit the article for publication. There are no other known conflicts of interest associated with this publication, and there has been no other significant financial support for this work that could have influenced its outcome.
Comment in
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EDITORIAL: The Bias of Seeing What You Look For.Cardiovasc Revasc Med. 2020 Jan;21(1):108-109. doi: 10.1016/j.carrev.2019.11.004. Epub 2019 Nov 15. Cardiovasc Revasc Med. 2020. PMID: 31759910 No abstract available.
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