Mechanisms of In-Stent Restenosis After Drug-Eluting Stent Implantation
Open Access
- 1 February 2011
- journal article
- research article
- Published by Ovid Technologies (Wolters Kluwer Health) in Circulation: Cardiovascular Interventions
- Vol. 4 (1), 9-14
- https://doi.org/10.1161/circinterventions.110.940320
Abstract
Background—: We used intravascular ultrasound (IVUS) to (1) clarify the mechanisms of luminal loss after drug-eluting stent (DES) implantation and (2) classify morphological patterns of in-stent restenosis (ISR). Methods and Results—: On the basis of IVUS-identified luminal narrowing (in-stent minimum lumen area 10 mm in length) with or without stent edge involvement. Significant intimal hyperplasia (IH) was defined as IH area >50% of stent. Overall, 76 lesions had IVUS-defined ISR; 32 (42%) had stent underexpansion (minimal stent area 50% of stent. Total stent length negatively correlated with minimal stent area ( r =−0.613, P r =−0.436, P 28 mm, even though there was significant IH in 34 (79%) lesions; conversely, in 32 of 33 (97%) lesions with stent length ≤28 mm, the minimum lumen site was not associated with stent underexpansion but significant IH. IVUS-defined focal ISR was most common (47%). Compared with focal ISR, normalized vessel, stent, lumen, and plaque volumes were smaller in diffuse and multifocal than focal ISR, with no difference in IH extent. Conclusions—: In most DES restenosis, IH was the dominant mechanism of ISR. Nevertheless, underexpansion associated with longer stent length remained an important preventable mechanism of ISR.Keywords
This publication has 16 references indexed in Scilit:
- A Randomized Comparison of Sirolimus- Versus Paclitaxel-Eluting Stent Implantation in Patients With Diabetes MellitusJournal of the American College of Cardiology, 2008
- Vascular Responses to Drug Eluting StentsArteriosclerosis, Thrombosis, and Vascular Biology, 2007
- Two-Year Follow-Up of the Quantitative Angiographic and Volumetric Intravascular Ultrasound Analysis After Nonpolymeric Paclitaxel-Eluting Stent Implantation: Late “Catch-Up” Phenomenon From ASPECT StudyJournal of the American College of Cardiology, 2006
- Patterns of restenosis after drug-eluting stent implantation: insights from a contemporary and comparative analysis of sirolimus- and paclitaxel-eluting stentsEuropean Heart Journal, 2006
- Intravascular ultrasound predictors of angiographic restenosis after sirolimus-eluting stent implantationEuropean Heart Journal, 2006
- Relationship between angiographic late loss and target lesion revascularization after coronary stent implantation: Analysis from the TAXUS-IV trialJournal of the American College of Cardiology, 2005
- Quantitative Assessment of Angiographic Restenosis After Sirolimus-Eluting Stent Implantation in Native Coronary ArteriesCirculation, 2004
- Sirolimus-Eluting Stents versus Standard Stents in Patients with Stenosis in a Native Coronary ArteryThe New England Journal of Medicine, 2003
- First Clinical Experience With a Paclitaxel Derivate–Eluting Polymer Stent System Implantation for In-Stent RestenosisCirculation, 2002
- Clinical validation of intravascular ultrasound imaging for assessment of coronary stenosis severity: Comparison with stress myocardial perfusion imagingJournal of the American College of Cardiology, 1999