Cardiology Medical News about zotarolimus-eluting stent, coronary artery disease, intravascular ultrasound

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Intravascular ultrasound results from the ENDEAVOR IV trial: Randomized comparison between zotarolimus- and paclitaxel-eluting stents in patients with coronary artery disease
JACC - Journal of the American College of Cardiology: Cardiovascular Interventions, 08/20/09

Waseda K et al. – Findings show different global and focal vessel responses for zotarolimus-eluting stents (ZES) and paclitaxel-eluting stents (PES). Both drug-eluting stents showed a similar incidence of lesions with severe narrowing, despite a moderate increase in neointimal hyperplasia ZES vs PES. A relatively lower neointima-free frame ratio in ZES suggests a greater extent of neointimal coverage.

Methods

Study to compare vessel response between ZES vs PES by intravascular ultrasound
ENDEAVOR IV: randomized controlled study of ZES (phosphorylcholine-coated, cobalt-alloy stents) for treatment of de novo coronary lesions vs PES for same treatment
Assessment of data from 198 pts with serial (baseline and 8-mo follow-up) intravascular ultrasound analysis
Volumetric analysis for vessel, lumen, plaque, stent, and neointima
Cross-sectional narrowing (%) defined as neointimal area divided by stent area
Neointima-free frame ratio calculated as number of frames without intravascular ultrasound-detectable neointima divided by total number of frames within stent
Subsegment analysis at every matched 1-mm subsegment throughout stent

Results

Significantly greater percentage of neointimal obstruction and maximum cross-sectional narrowing with smaller minimum lumen area for ZES vs PES group
Incidence of maximum cross-sectional narrowing >50% similar for both groups
Significantly lower neointima-free frame ratio in ZES group
Overall analysis, positive remodeling during follow-up for PES group vs no significant difference for ZES group
Subsegment analysis: significant focal positive vessel remodeling in 5% of ZES and 25% of PES cases

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