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.
Cardiovascular Research Foundation, Lenox Hill Heart and Vascular Institute, New York, NY 10021, USA.
Kenichi
K
Fujii
Gary S
GS
Mintz
Yoshio
Y
Kobayashi
Stéphane G
SG
Carlier
Hideo
H
Takebayashi
Takenori
T
Yasuda
Issam
I
Moussa
George
G
Dangas
Roxana
R
Mehran
Alexandra J
AJ
Lansky
Arlene
A
Reyes
Edward
E
Kreps
Michael
M
Collins
Antonio
A
Colombo
Gregg W
GW
Stone
Paul S
PS
Teirstein
Martin B
MB
Leon
Jeffrey W
JW
Moses
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