Coronary restenosis after sirolimus-eluting stent implantation: morphological description and mechanistic analysis from a consecutive series of cases.
BACKGROUND
We describe the clinical and morphological patterns of restenosis after sirolimus-eluting stent (SES) implantation.


RESULTS
From 121 patients with coronary angiography obtained >30 days after SES implantation, restenosis (diameter stenosis >50%) was identified in 19 patients and 20 lesions (located at the proximal 5-mm segment in 30% or within the stent in 70%). Residual dissection after the procedure or balloon trauma outside the stent was identified in 83% of the proximal edge lesions. Lesions within the stent were focal, and stent discontinuity was identified in some lesions evaluated by intravascular ultrasound.


CONCLUSIONS
Sirolimus-eluting stent edge restenosis is frequently associated with local trauma outside the stent. In-stent restenosis occurs as a localized lesion, commonly associated with a discontinuity in stent coverage. Local conditions instead of intrinsic drug-resistance to sirolimus are likely to play a major role in post-SES restenosis.
Lemos
Pedro A
PA
Erasmus Medical Center, Thoraxcenter, Bd-406, Dr Molewaterplein 40, 3015-GD Rotterdam, The Netherlands.
Saia
Francesco
F
Ligthart
Jurgen M R
JM
Arampatzis
Chourmouzios A
CA
Sianos
Georgios
G
Tanabe
Kengo
K
Hoye
Angela
A
Degertekin
Muzaffer
M
Daemen
Joost
J
McFadden
Eugene
E
Hofma
Sjoerd
S
Smits
Pieter C
PC
de Feyter
Pim
P
van der Giessen
Willem J
WJ
van Domburg
Ron T
RT
Serruys
Patrick W
PW
D000328:Adult; D000368:Aged; D015906:Angioplasty, Balloon, Coronary; D019917:Blood Vessel Prosthesis Implantation / Q000009:adverse effects*; D017023:Coronary Angiography; D023903:Coronary Restenosis / Q000175:diagnosis* / Q000209:etiology*; D004343:Drug Implants / Q000009:adverse effects; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007166:Immunosuppressive Agents / Q000009:adverse effects; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications / Q000175:diagnosis / Q000209:etiology; D012042:Registries; D020123:Sirolimus / Q000009:adverse effects*; D015607:Stents / Q000009:adverse effects*; D016896:Treatment Outcome; D018084:Ultrasonography, Interventional
D004343:Drug Implants; D007166:Immunosuppressive Agents; D020123:Sirolimus