Contribution of stent underexpansion to recurrence after sirolimus-eluting stent implantation for in-stent restenosis.
BACKGROUND
We used intravascular ultrasound (IVUS) to evaluate recurrence after sirolimus-eluting stent (SES) implantation treatment of in-stent restenosis (ISR).


RESULTS
Forty-eight ISR lesions (41 patients with objective evidence of ischemia) were treated with SES. Recurrent ISR was identified in 11 lesions (all focal); repeat revascularization was performed in 10. These were compared with 16 patients (19 lesions) without recurrence as documented by angiography. Nine of 11 recurrent lesions had a minimum stent area (MSA) <5.0 mm2 versus 5 of 19 nonrecurrent lesions (P=0.003); 7 of 11 recurrent lesions had an MSA <4.0 mm2 versus 4 of 19 nonrecurrent lesions (P=0.02); and 4 of 11 recurrent lesions had an MSA <3.0 mm2 versus 1 of 19 nonrecurrent lesions (P=0.03). A gap between SESs was identified in 3 of 11 recurrences versus 1 of 19 nonrecurrent lesions.


CONCLUSIONS
Stent underexpansion is a significant cause of failure after SES implantation treatment of ISR.
Fujii
Kenichi
K
Cardiovascular Research Foundation, Lenox Hill Heart and Vascular Institute, New York, NY 10021, USA.
Mintz
Gary S
GS
Kobayashi
Yoshio
Y
Carlier
Stéphane G
SG
Takebayashi
Hideo
H
Yasuda
Takenori
T
Moussa
Issam
I
Dangas
George
G
Mehran
Roxana
R
Lansky
Alexandra J
AJ
Reyes
Arlene
A
Kreps
Edward
E
Collins
Michael
M
Colombo
Antonio
A
Stone
Gregg W
GW
Teirstein
Paul S
PS
Leon
Martin B
MB
Moses
Jeffrey W
JW
D003131:Combined Modality Therapy; D017023:Coronary Angiography; D023903:Coronary Restenosis / Q000175:diagnosis / Q000000981:diagnostic imaging / Q000628:therapy*; D016503:Drug Delivery Systems; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D020123:Sirolimus / Q000008:administration & dosage* / Q000627:therapeutic use; D015607:Stents; D017211:Treatment Failure; D014463:Ultrasonography
D020123:Sirolimus