Early lumen loss after treatment of in-stent restenosis: an intravascular ultrasound study.
BACKGROUND
Mechanisms of recurrence after treatment of in-stent restenosis are unknown.


RESULTS
We prospectively performed quantitative coronary angiography (QCA) and intravascular ultrasound (IVUS) in 37 lesions with Palmaz-Schatz stents enrolled in a study of intracoronary radiation for in-stent restenosis. Primary treatment was at the discretion of the operator: PTCA (n=8) or ablation+adjunct PTCA (n=29). Lesions were studied before intervention, immediately after primary intervention, and 42+/-8 minutes later. QCA measurements included minimal luminal diameter and diameter stenosis. Planar IVUS measurements included arterial, stent, lumen, and in-stent tissue areas. Stent, lumen, and in-stent tissue volumes were calculated by use of Simpson's rule. Compared with immediately after intervention, the delayed (42+/-8 minutes) minimal lumen area decreased by 20% (5.8+/-1.9 to 4.5+/-1.3 mm2, P<0.0001) and the lumen volume by 12% (58+/-41 to 52+/-37 mm3, P=0.0001). Ten lesions (27%) had a > or = 2.0-mm2 decrease in minimum lumen area. Lumen loss (1) resulted from increased tissue with the stent, (2) correlated with lesion length and preintervention in-stent tissue, and (3) was not seen angiographically.


CONCLUSIONS
There is significant tissue reintrusion shortly after catheter-based treatment of in-stent restenosis. This was greater in longer lesions and those with a larger in-stent tissue burden, was not reflected in the QCA measurements, and may contribute to recurrence.
Shiran
A
A
Intravascular Ultrasound Imaging Laboratory, Washington Hospital Center, Washington, DC, USA.
Mintz
G S
GS
Waksman
R
R
Mehran
R
R
Abizaid
A
A
Kent
K M
KM
Pichard
A D
AD
Satler
L F
LF
Popma
J J
JJ
Leon
M B
MB
D000368:Aged; D015906:Angioplasty, Balloon, Coronary; D006328:Cardiac Catheterization; D017023:Coronary Angiography; D003327:Coronary Disease / Q000000981:diagnostic imaging* / Q000628:therapy*; D003331:Coronary Vessels / Q000000981:diagnostic imaging* / Q000528:radiation effects; D005260:Female; D005720:Gamma Rays / Q000627:therapeutic use; D006801:Humans; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D012008:Recurrence; D019233:Retreatment; D015607:Stents; D016896:Treatment Outcome; D018084:Ultrasonography, Interventional