Comparison of endothelial shear stress between ultrathin strut Bioresorbable Polymer Drug Eluting Stent vs Durable Polymer Drug Eluting Stent post-stent implantation: An optical coherence tomography substudy from BIOFLOW II.

Beyene, Solomon; Tufaro, Vincenzo; Garg, Mohil; Gkargkoulas, Fotis; Calderon, Andrea Teira; Safi, Hannah; Waksman, Ron; Windecker, Stephan; Torii, Ryo; Melaku, Gebremedhin D; Bulant, Carlos A; Bourantas, Christos V; Blanco, Pablo J; Garcia-Garcia, Hector M (2024). Comparison of endothelial shear stress between ultrathin strut Bioresorbable Polymer Drug Eluting Stent vs Durable Polymer Drug Eluting Stent post-stent implantation: An optical coherence tomography substudy from BIOFLOW II. Cardiovascular revascularization medicine, 61, pp. 26-34. Elsevier 10.1016/j.carrev.2023.11.014

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BACKGROUND

Recent clinical data indicate a different performance of biodegradable polymer (BP)-drug eluting stent (DES) compared to durable polymer (DP)-DES. Whether this can be explained by a beneficial impact of BP-DES stent design on the local hemodynamic forces distribution remains unclear.

OBJECTIVES

To compare endothelial shear stress (ESS) distribution after implantation of ultrathin (us) BP-DES and DP-DES and examine the association between ESS and neointimal thickness (NIT) distribution in the two devices at 9 months follow up.

METHODS AND RESULTS

We retrospectively identified patients from the BIOFLOW II trial that had undergone OCT imaging. OCT data were utilized to reconstruct the surface of the stented segment at baseline and 9 months follow-up, simulate blood flow, and measure ESS and NIT in the stented segment. The patients were divided into 3 groups depending on whether DP-DES (N = 8, n = 56,160 sectors), BP-DES with a stent diameter of >3 mm (strut thickness of 80 μm, N = 6, n = 36,504 sectors), or BP-DES with a stent diameter of ≤3 mm (strut thickness of 60 μm, N = 8, n = 50,040 sectors) were used for treatment. The ESS, and NIT distribution and the association of these two variables were estimated and compared among the 3 groups.

RESULTS

In the DP-DES group mean NIT was 0.18 ± 0.17 mm and ESS 1.68 ± 1.66 Pa; for the BP-DES ≤3 mm group the NIT was 0.17 ± 0.11 mm and ESS 1.49 ± 1.24 Pa and for the BP-DES >3 mm group 0.20 ± 0.23 mm and 1.42 ± 1.24 Pa respectively (p < 0.001 for both NIT and ESS comparisons across groups). A negative correlation between NIT and baseline ESS was found, the correlation coefficient for all the stented segments was -0.33, p < 0.001.

CONCLUSION

In this OCT sub-study of the BIOFLOW II trial, the NIT was statistically different between groups of patients treated with BP-DES and DP-DES. In addition, regions of low ESS were associated with increased NIT in all studied devices.

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