Angioscopic Comparison of Six-month Arterial Healing between Bare-metal and Drug-eluting Stents in Superficial Femoral Arteries

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Several clinical studies have shown comparative outcomes of paclitaxel-eluting stent (PES), Zilver PTX and bare-metal stent (BMS), Zilver implanted into the superficial femoral artery. However, detailed process of vascular healing after implantation of the 2 different stents is little known. We assessed a total of 3 patients of successfully deployed 1 BMS and 2 PES who underwent angiographic and angioscopic follow-ups after 6 months of the intervention. The degree of neointimal stent coverage (NSC) was classified into presence of uncovered struts (grade 0), visible struts through a thin neointima (grade 1), or invisible struts with complete neointimal coverage (grade 2). Also, the existence of in-stent thrombus was also evaluated qualitatively using angioscopy. In a case of BMS, follow-up angiography confirmed stent patency. Angioscopy showed that stent struts were fully and homogeneously covered by proliferating white neointima (grade 2) without thrombus. One PES was angiographically patent but another showed diffuse restenosis. In a case without restenosis, angioscopy showed heterogeneous neointimal coverage within the PES segment. Although stent struts were clearly visible and neointimal coverage was absent (grade 0) at the proximal site, thick neointima covered stent and the struts were invisible (grade 2) at the mid and distal segments without thrombus. In a case of restenosis, angioscopy found thin and thick neointima (grade 1 and 2, respectively) as heterogeneous artery healing of the PES with no thrombus. This angioscopic observation revealed that heterogeneous growth of neointima in Zilver PTX, while Zilver showed homogenous healing at 6 months of their implantation.

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