94% of researchers rate our articles as excellent or good
Learn more about the work of our research integrity team to safeguard the quality of each article we publish.
Find out more
ORIGINAL RESEARCH article
Front. Cardiovasc. Med.
Sec. Cardiovascular Imaging
Volume 12 - 2025 | doi: 10.3389/fcvm.2025.1491607
Interpreting Clinical Outcomes Using Different Strut Thickness in Coronary Artery Disease: Insights from Vascular Imaging Analysis
Provisionally accepted
Ju-Seung Kwun 1
Jin Joo Park 1 Si-Hyuck Kang 1 Sun-Hwa Kim 1 Jung-Won Suh 1 Tae- Jin Youn 1 Kwang Soo Cha 2 Seung-Hwan Lee 3 Bum-Kee Hong 4 Seung-Woon Rha 5 Woong Chol Kang 6 In-Ho Chae 1
Chang-Hwan Yoon 1*- 1 Seoul National University Bundang Hospital, Seongnam-si, Gyeonggi, Republic of Korea
- 2 Pusan National University Hospital, Seo-gu, Busan, Republic of Korea
- 3 Wonju Severance Christian Hospital, Wŏnju, Republic of Korea
- 4 Gangnam Severance Hospital, Seoul, Seoul, Republic of Korea
- 5 Korea University Guro Hospital, Seoul, Republic of Korea
- 6 Gachon University Gil Hospital, Incheon, Incheon, Republic of Korea
Background: Coronary artery disease is a global health concern that necessitates treatments, such as percutaneous coronary intervention (PCI) with drug-eluting stents (DES). Recent advancements in biodegradable polymer-coated DES have improved long-term outcomes by reducing neointimal hyperplasia. Superior long-term outcomes in patients with ultrathin-strut sirolimus-eluting Orsiro stent (BP-SES) compared with those with thick-strut biolimus-eluting BioMatrix stent (BP-BES) have been shown. This study aimed to explore the mechanisms underlying these differences by using quantitative coronary angiography (QCA) and optical coherence tomography (OCT).This sub-analysis of the BIODEGRADE trial, a prospective, randomized, multicenter study, compared BP-SES and BP-BES in patients who underwent PCI between July 2014 and September 2017. Patients with positive stress test results, ischemic symptoms, or those who consented to routine follow-up angiography were included. QCA and OCT were used to evaluate the lumen diameter, cross-sectional areas and stent apposition or coverage. OCT images were analyzed at 1 mm intervals within 5 mm proximal and distal to the stented segment.Results: Of the 2,341 patients, 689 underwent follow-up angiography between 18-and 36months post-PCI, and 929 stents were analyzed via QCA. OCT images of 61 participants were available. The BP-SES group exhibited a significantly larger minimal lumen diameter and reduced late lumen loss compared to the BP-BES group (0.34±0.45 mm vs. 0.42±0.44 mm, P=0.005). OCT analysis showed significantly less neointimal hyperplasia in the BP-SES group (0.04±0.4 mm² vs. 0.64±0.54 mm², P<0.001), with no significant differences in stent strut coverage or inflammation markers, than in the BP-BES group.Conclusions: QCA and OCT analyses revealed less neointimal growth with BP-SES than with BP-BES, without delayed healing or increased inflammation. These findings underscore the importance of stent design characteristics and suggest that thinner struts may enhance clinical success by reducing restenosis and improving long-term vessel patency.
Keywords: ultrathin-strut drug-eluting stent, Quantitative coronary analysis, Optical Coherence Tomography, Percutaneous Coronary Intervention, Coronary Artery Disease
Received: 05 Sep 2024; Accepted: 17 Feb 2025.
Copyright: © 2025 Kwun, Park, Kang, Kim, Suh, Youn, Soo Cha, Lee, Hong, Rha, Kang, Chae and Yoon. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) or licensor are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.
* Correspondence:
Chang-Hwan Yoon, Seoul National University Bundang Hospital, Seongnam-si, 13620, Gyeonggi, Republic of Korea
Disclaimer: All claims expressed in this article are solely those of the authors and do not necessarily represent those of their affiliated organizations, or those of the publisher, the editors and the reviewers. Any product that may be evaluated in this article or claim that may be made by its manufacturer is not guaranteed or endorsed by the publisher.