title: Intravascular ultrasound characterization of the "black hole" phenomenon after drug-eluting stent implantation.
abstract: An intraluminal echolucent tissue, dubbed "black hole," has been identified by intravascular ultrasonography after intracoronary brachytherapy. This study reports the characteristics and incidence of the black hole in patients treated with drug-eluting stent implantation using a sirolimus-eluting stent (SES). We included intravascular ultrasound data from the Compassionate Use of Sirolimus-Eluting Stent (SECURE, n = 61 lesions) registry, a study involving patients in whom previous brachytherapy had failed, and the DIABETES trial (n = 165 lesions), a multicenter, randomized study comparing SES versus bare metal stents in diabetic patients. Intravascular ultrasound follow-up was scheduled at 8 months (SECURE trial, post-brachytherapy population) and 9 months (DIABETES trial). In the SECURE population, a black hole was observed in 10 patients (19.6%). Seven black hole segments had significant intimal hyperplasia (> 10%). A black hole accounted for 27% of total intraluminal tissue. In the DIABETES trial, 2 patients (2.5%) in the SES group and none in the bare metal stent group showed echolucent intimal hyperplasia. In conclusion, a black hole occurred frequently after implantation of a SES in patients in whom intracoronary brachytherapy had previously failed. Black holes were also identified in a nonirradiated population, although the incidence was lower than in the post-brachytherapy patients. Bare metal stents were not associated with this phenomenon.
authors.affiliation: Division of Cardiology, University of Florida, Shands-Jacksonville, Florida, USA. marco.costa@jax.ufl.edu
authors.forename: Marco A
authors.initials: MA
authors.lastname: Costa
authors.forename: Manel
authors.initials: M
authors.lastname: Sabate
authors.forename: Dominick J
authors.initials: DJ
authors.lastname: Angiolillo
authors.forename: Pilar
authors.initials: P
authors.lastname: Jimenez-Quevedo
authors.forename: Paul
authors.initials: P
authors.lastname: Teirstein
authors.forename: Andrew
authors.initials: A
authors.lastname: Carter
authors.forename: Martin B
authors.initials: MB
authors.lastname: Leon
authors.forename: Jeffrey
authors.initials: J
authors.lastname: Moses
authors.forename: Martin
authors.initials: M
authors.lastname: Zenni
authors.forename: Steven
authors.initials: S
authors.lastname: Yakubov
authors.forename: Luis A
authors.initials: LA
authors.lastname: Guzman
authors.forename: Paul
authors.initials: P
authors.lastname: Gilmore
authors.forename: Carlos
authors.initials: C
authors.lastname: Macaya
authors.forename: Theodore A
authors.initials: TA
authors.lastname: Bass
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000787:Angina Pectoris / Q000473:pathology / Q000628:therapy; D001918:Brachytherapy; D003327:Coronary Disease / Q000473:pathology / Q000628:therapy*; D003331:Coronary Vessels / Q000473:pathology*; D003925:Diabetic Angiopathies / Q000473:pathology / Q000628:therapy*; D005260:Female; D006801:Humans; D007166:Immunosuppressive Agents / Q000008:administration & dosage*; D008297:Male; D008875:Middle Aged; D020123:Sirolimus / Q000008:administration & dosage*; D015607:Stents; D017539:Tunica Intima; D018084:Ultrasonography, Interventional
chemical_list: D007166:Immunosuppressive Agents; D020123:Sirolimus