Comparison of paclitaxel-eluting vs. everolimus-eluting stents implanted simultaneously in different lesions of the same coronary artery: 12-month follow-up with optical coherence tomography

Aims: Optical coherence tomography (OCT) allows a detailed assessment of intimal coverage and strut apposition which are well known substrates for late thrombosis. This study sought to assess and compare long-term coverage and apposition of PBS and EES implanted in different lesions of the same coronary artery (and in the same patient). Methods and results: A total of 30 patients were included. In these patients PES and EES were implanted in the same vessel in two similar lesions. The selection of the stent for each lesion was random. At 12 months, 30 PBS were examined analysing 154 +/- 90 struts/stents and 30 EES analysing 158 +/- 72 struts/stents. The proportion of uncovered struts was 0.8 +/- 1.3% for EES and 1.5 +/- 2.9% for PBS (p=0.3), and the proportion of malapposed struts was 1.25 +/- 2.1% and 0.98 +/- 2%, respectively (p=0.2). A pooled analysis was performed using the random effects model, given the significant heterogeneity found, which did not show significant differences between EES and PES for non-coverage (RR 0.73, 95% CI: 0.32-1.67) or malapposition (RR 1.60, 95% CI: 0.56-4.61). The presence of non-coverage in malapposed struts was 62% with PBS and 15% with EES (p<0.0001), the maximal malapposition area being significantly larger with PBS (0.6 +/- 0.3 vs. 0.25 +/- 0.2 mm(2), p=0.001). Conclusions: In highly matched conditions, with PBS and EES implanted in the same artery, both DES showed a comparable degree of intimal coverage and apposition at one-year follow-up. A smaller area of malapposition with non-covered struts was found with EES.