Evaluation of Four-Year Coronary Artery Response After Sirolimus-Eluting Stent Implantation Using Serial Quantitative Intravascular Ultrasound and Computer-Assisted Grayscale Value Analysis for Plaque Composition in Event-Free Patients Original Research

Objectives This study sought to evaluate the long-term arterial response after sirolimus-eluting stent implantation. Background Sirolimus-eluting stents are effective in inhibiting neointimal hyperplasia without affecting plaque volume behind the stent struts at six months. Methods Serial quantitative intravascular ultrasound and computer-assisted grayscale value analysis over four years were performed in 23 event-free patients treated with sirolimus-eluting stents. Results In the first two years, the mean plaque volume (155.5 ± 42.8 mm3 post-procedure and 156.8 ± 57.7 mm3 at two years, p = 0.86) and plaque compositional change expressed as mean percent hypoechogenic tissue of the plaque behind the stent struts (78.9 ± 8.6% post-procedure and 78.2 ± 8.9% at two years, p = 0.67) did not significantly change. However, significant plaque shrinking (change in plaque volume = −18.4 mm3, p = 0.02) with an increase in plaque echogenicity (change in percent hypoechogenic tissue = −7.8%, p < 0.0001) was observed between two and four years. The mean neointimal volume increased over four years from 0 to 8.4 ± 5.8 mm3 (p < 0.0001). However, no further statistically significant change occurred between two and four years (7.0 ± 6.7 mm3 vs. 8.4 ± 5.8 mm3, p = 0.25). Conclusions Between two and four years after sirolimus-eluting stent implantation, peri-stent tissue shrank with a concomitant increase in echogenicity. These intravascular ultrasound findings suggest that late chronic artery responses may evolve for up to four years after sirolimus-eluting stent implantation. In addition, the fact that the neointima does not significantly change from two to four years may suggest that the biological phenomenon of a delayed healing response has begun to subside.