title: Coronary restenosis after sirolimus-eluting stent implantation: morphological description and mechanistic analysis from a consecutive series of cases.
abstract: 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.
authors.affiliation: Erasmus Medical Center, Thoraxcenter, Bd-406, Dr Molewaterplein 40, 3015-GD Rotterdam, The Netherlands.
authors.forename: Pedro A
authors.initials: PA
authors.lastname: Lemos
authors.forename: Francesco
authors.initials: F
authors.lastname: Saia
authors.forename: Jurgen M R
authors.initials: JM
authors.lastname: Ligthart
authors.forename: Chourmouzios A
authors.initials: CA
authors.lastname: Arampatzis
authors.forename: Georgios
authors.initials: G
authors.lastname: Sianos
authors.forename: Kengo
authors.initials: K
authors.lastname: Tanabe
authors.forename: Angela
authors.initials: A
authors.lastname: Hoye
authors.forename: Muzaffer
authors.initials: M
authors.lastname: Degertekin
authors.forename: Joost
authors.initials: J
authors.lastname: Daemen
authors.forename: Eugene
authors.initials: E
authors.lastname: McFadden
authors.forename: Sjoerd
authors.initials: S
authors.lastname: Hofma
authors.forename: Pieter C
authors.initials: PC
authors.lastname: Smits
authors.forename: Pim
authors.initials: P
authors.lastname: de Feyter
authors.forename: Willem J
authors.initials: WJ
authors.lastname: van der Giessen
authors.forename: Ron T
authors.initials: RT
authors.lastname: van Domburg
authors.forename: Patrick W
authors.initials: PW
authors.lastname: Serruys
mesh_terms: 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
chemical_list: D004343:Drug Implants; D007166:Immunosuppressive Agents; D020123:Sirolimus