Comparison of zotarolimus-eluting stents with sirolimus-eluting and everolimuseeluting stents in patients with long coronary artery lesions intimal hyperplasia and vascular changes assessed by volumetric intravascular ultrasound analysis

Background: As a substudy of the large, randomized LONG-DES-III (Percutaneous Treatment of LONG Native Coronary Lesions With Drug- Eluting Stent-III) trial comparing first- and second-generation drugeluting stents, we sought to investigate intimal hyperplasia (IH) and vascular changes using volumetric intravascular ultrasound analysis. Methods: Complete angiographic and volumetric intravascular ultrasound data immediately after stenting and at 9-month follow-up were available in 260 patientswith 287 lesions: 137 sirolimus-eluting stents (SES), 61 everolimus-eluting stents (EES), and 89 zotarolimus-eluting stents (ZES). External elastic membrane, stent, lumen, and peristent plaque volumes (external elastic membrane minus stent) were normalized by stent length. Results: Normalized IH volumes were calculated calculated as [IH volume/stent length] was greater in EES than sirolimus (0.7±0.4mm2 vs 0.5±0.4mm2 p <0.05), whereas normalized IH volume in ZES was not significantly different from SES (0.5 ±0.4mm2 vs 0.5 ±0.4mm2). Changes normalized EEM volume was lesser in EES than SES (0.1 ± 1.2mm2 vs 0.6 ± 1.5mm2 p <0.05). Comparing ZES versus SES, there was no signicant differences in changes normalized EEM volume (0.6 ± 1.5mm2 vs 0.6 ± 1.1mm2 ). Late stent malapposition was identified in 9 (7%) SES and 1 (1%) ZES but in no EES. Conclusion: The degree of neointimal growth in ZES was similar to that in SES but less than that in EES.