Optical coherence tomography evaluation of intermediate-term healing of different stent types: systemic review and meta-analysis

Eur Heart J Cardiovasc Imaging. 2017 Feb;18(2):159-166. doi: 10.1093/ehjci/jew070. Epub 2016 Apr 20.


Aims: The intermediate-term incidence of strut malapposition (SM) and uncovered struts (US), and the degree of neointimal thickness (NIT) according to stent type have not been characterized.

Methods and results: All studies of >50 patients in which optical coherence tomography was performed between 6 and 12 months after stent implantation were included. The incidences of SM and US were the co-primary end points, while NIT was the secondary end point. A total of 458 citations were initially appraised at the abstract level, and 11 full-text studies (280 652 analysed struts, 921 patients) were assessed. The 6-12 months incidences of SM and US were 5.0 and 7.8%, respectively, and the mean NIT was 206 μm. Biolimus-eluting stents (BES) and bioresorbable vascular scaffolds (BVS) had the highest SM rates (2.7 and 3.8%, respectively), while everolimus-eluting stents (EES) and fast-release zotarolimus-eluting stents (ZES) had the lowest SM rates (0.9 and 0.1%, respectively). BES and sirolimus-eluting stents (SES) had the highest US rates (7.7 and 8.8%, respectively), while bare metal stents (BMS) and ZES had the lowest US rates (0.3 and 0.3%, respectively). BMS had the greatest NIT (340 μm), while SES, EES, and BES had the least NIT.

Conclusion: Second-generation drug-eluting stents (DES) have better intermediate-term strut apposition and coverage than first-generation DES, BVS, and BMS. EES demonstrate the overall best combination of healing with suppression of neointimal hyperplasia at 6-12 months. Further studies with clinical correlation are warranted to determine the implications of these findings.

Keywords: BV; EES; OCT; drug-eluting stent; neointima thickness; optical coherence tomograph; strut malapposition; strut uncoverage.

Publication types

  • Comparative Study
  • Meta-Analysis
  • Review

MeSH terms

  • Adult
  • Aged
  • Angioplasty, Balloon, Coronary / adverse effects
  • Angioplasty, Balloon, Coronary / instrumentation*
  • Angioplasty, Balloon, Coronary / methods
  • Cohort Studies
  • Coronary Stenosis / diagnostic imaging*
  • Coronary Stenosis / therapy*
  • Drug-Eluting Stents*
  • Female
  • Follow-Up Studies
  • Humans
  • Male
  • Middle Aged
  • Prosthesis Failure*
  • Randomized Controlled Trials as Topic
  • Retrospective Studies
  • Risk Assessment
  • Stents
  • Time Factors
  • Tomography, Optical Coherence / methods*
  • Treatment Outcome