Abstract
Purpose: Geometric changes in the coronary arteries at the site of coronary stent implantation can lead wall shear stress reduction with decreased coronary flow, which affect the clinical outcome after coronary intervention. Newly developed Platinum Chromium (PtCr)-Everolimus-eluting stent (EES) is expected to improve vessel conformability and restore the natural shape of the vessel with its modified scaffold design, using the same durable polymer and antiproliferative drug as the Cobalt Chromium (CoCr)-EES. The aim of this study was to investigate the long-term effect of PtCr-EES implantation on in-stent restenosis in angulated coronary lesions, comparing with CoCr-EES. Methods: This retrospective study included 250 lesions with CoCr-EES implantation and 217 lesions with PtCr-EES implantation for de novo angulated lesions (>45-degree by quantitative coronary angiography). The angle of the lesions was measured in diatole and systole, and cyclic changes in the coronary angle >20 degree was defined as hinge-like motion. Long-term coronary in-stent restenosis was defined as >50% angiographic stenosis in 8 month after the procedure. Results: Changes in maximum coronary angle at the site of stent implantation were significantly smaller in PtCr-EES group than in CoCr-EES group compared with original angle (20.65±15.42 vs. 26.25±18.36 degree, p <0.01). There were no significant differences in the occurrence of significant in-stent restenosis between PtCr-EES and CoCr-EES (6.7% vs 10.1%, p=0.32). CoCr-EES tended to show more restenosis than PtCr-EES (12.9% vs. 0.0%, p=0.07) in extremely angulated lesions (>100-degree). Interestingly, in the lesions with hinge-like motion, PtCr-EES group showed significantly higher rate of restenosis compared with CoCr-EES group (26.3% vs 7.7%, p= 0.04). Conclusions: In comparison with CoCr-EES, PtCr-EES tended to restore the original curvature of the coronary vessels, and this may lead less restenosis rate in extremely angulated lesions. However, PrCr-EES might have adverse effect on long-term result after coronary stenting in the lesion with hinge-like cyclic motion.
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