1. Assessment of Vascular Patency and Inflammation with Intravascular Optical Coherence Tomography in Patients with Superficial Femoral Artery Disease Treated with Zilver PTX Stents.
- Author
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Hoyt T, Feldman MD, Okutucu S, Lendel V, Marmagkiolis K, McIntosh V, Ates I, Kose G, Mego D, Paixao A, Iliescu C, Park J, Shaar M, Avci R, McElroy A, Dijkstra J, Milner TE, and Cilingiroglu M
- Subjects
- Aged, Aged, 80 and over, Alloys, Angioplasty, Balloon adverse effects, Cardiovascular Agents adverse effects, Female, Femoral Artery physiopathology, Humans, Inflammation etiology, Inflammation physiopathology, Male, Middle Aged, Neointima, Paclitaxel adverse effects, Peripheral Arterial Disease diagnostic imaging, Peripheral Arterial Disease physiopathology, Predictive Value of Tests, Prospective Studies, Prosthesis Design, Risk Factors, Time Factors, Treatment Outcome, Vascular Remodeling, Angioplasty, Balloon instrumentation, Cardiovascular Agents administration & dosage, Drug-Eluting Stents, Femoral Artery diagnostic imaging, Inflammation diagnostic imaging, Paclitaxel administration & dosage, Peripheral Arterial Disease therapy, Self Expandable Metallic Stents, Tomography, Optical Coherence, Vascular Patency
- 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 mm
2 . 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., Competing Interests: 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., (Copyright © 2019 Elsevier Inc. All rights reserved.)- Published
- 2020
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