The stented vessel wall Dr Miles Dalby Consultant Cardiologist Royal Brompton Hospital Harefield Hospital Senior Lecturer Imperial College Conflicts of interest Dr Dalby has received travel expences speaking honoraria and research grants from Eli Lilly, Translumina, Sankyo. DRUG ELUTING STENT IN STENT RESTENOSIS STENT THROMBOSIS HEALING ENDOTHELIALISATION COVERAGE Paradigms in stent evaluation VESSEL WALL VESSEL LUMEN MLD BARE METAL STENT ACUTE VESSEL CLOSURE IN STENT RESTENOSIS ANGIOGRAPHIC RESTENOSIS LATE LUMEN LOSS CLINICAL RESTENOSIS MINIMUM LUMEN DIAMETER Lady diana fountain Particle residence and shear Terminology in stent coverage ESC Congress Munich 2008 Optical Coherence Tomography OCT and stent imaging A Randomised optical coherence tomography study to determine 90 day stent coverage in polymer coated vs bare metal rapamicin eluting stents P Moore, P Barlis, J Spiro, G Ghimire, M Roughton, C DiMario, C Ilsley, M Mason, R Kharbanda, M Dalby Yukon using rapamicin without polymer enhances stent coverage : Youre Covered ISRCTN no Royal Brompton & Harefield University Hospitals Imperial College London UK Dr Dalby has received an unrestricted educational grant, honoraria and travel expenses from Translumina ESC Congress Munich 2008 Rapamicin Eluting Stents YUKON Etched surface Drug sprayed on No Polymer CYPHER Polymer coated PEVA PBMA Study Hypothesis The Yukon rapamicin eluting non- polymer coated stent has improved strut coverage compared to the Cypher durable polymer coated rapamicin eluting stent as judged by OCT at 90 days ESC Congress Munich 2008 Study Design N=24 DES eligible PCI Cypher n=12 Yukon n=12 OCT at 90 days Primary Randomisation guided by UK NICE criteria for DES/BMS Primary End point: Neointimal thickness at 90 days (um) Binary strut coverage at 90 days (%) Stent Strut Luminal Protrusion (%) ESC Congress Munich 2008 VariablePolymer-coated rapamycin stentnon-polymer rapamycin stent Number12 Age (years)61.6 (55.0, 66.2)62.3 (53.7, 63.8) Male11 (92)10 (83) Follow-up (mean days)91 (85, 92)91 (86, 96) Hypertension8 (67) Diabetes mellitus4 (42)3 (25) Hypercholesterolaemia10 (83)11 (92) Current or Ex-smoker6 (50)7 (58) Acute coronary syndrome 4 (33)3 (25) Chronic stable angina6 (67)9 (75) Patient Characteristics ESC Congress Munich 2008 Variable Polymer coater rapamicin stent Non-Polymer rapamicin stent p value Vessel treatedLAD 9 Cx 1 RCA 1LAD 6 Cx 4 RCA 2 Stent diameter(mm)2.88 (0.20)2.88 (0.38)1 Stent length(mm)18.0 (3.0)20.2 (2.9)0.089 Postdilatation, n (%)5 (41.7)1 (8.3)0.059 Max inflation pressure(atm)17.0 (3.1)16.7 (2.8)0.785 Inflation duration(s)18.9 (6.2)15.4 (7.2) stent, n (%)8 (66.7)6 (50.0) stents, n (%)3 (25.0)6 (50.0) 3 stents, n (%)1 (8.3)0 (0) Stent:Artery ratio1.14 (0.09)1.06 (0.09)0.034 Procedural Characteristics ESC Congress Munich 2008 Variable Polymer coater rapamicin stent Non-Polymer rapamicin stent p value 90 day binary restenosis, n (%) 0 (0) 1 Late loss (mm)0.06 (0.29)0.16 (0.33)0.417 Angiographic 90 day Outcome There were no clinical adverse events at 90 days and no OCT related complications Results: LAD PCI 90 Day ESC Congress Munich 2008 Results: LAD PCI 90 Day OCT pullback from mid-proximal LAD ESC Congress Munich 2008 Results: RCA PCI 90 Day ESC Congress Munich 2008 Results: RCA PCI 90 Day OCT pullback from mid-proximal RCA ESC Congress Munich 2008 CypherYukon Results: Neointimal Thickness P10% of struts being uncovered by OCT criteria with the polymer coated rapamicin stent compared with 25% of sections with the polymer coated rapamicin stent compared with