Heterogeneity of neointimal distribution of in-stent restenosis in patients with diabetes mellitus.
Diabetes mellitus is an independent predictor of restenosis after percutaneous coronary intervention. The pattern of restenosis after bare metal stent implantation in diabetic patients was examined with 3-dimensional intravascular ultrasound analysis. Lumen and stent were manually traced at every 0.5-mm interval in stented segments. Using Simpson's method, stent, luminal, and neointimal (stent minus lumen) volumes were calculated and average area was calculated as volume data divided by length. To measure the cross-sectional and longitudinal severities of luminal encroachment by the neointima, percent neointimal area (neointimal area divided by stent area) and neointimal hyperplasia 50 (IH50) (defined as percent stent length with percent neointimal area >50%) were calculated. In 278 patients (68 with diabetes and 210 without diabetes), there was a significantly higher percentage of maximal percent neointimal area with significantly longer percent stent length that was severely encroached by the neointima in diabetic patients. Diabetic patients showed a more heterogenous pattern of the neointima after bare metal stenting, resulting in longer high-grade obstruction segments. This may have important implications for stent design and pharmacokinetic properties of next-generation drug-eluting technology for this complex patient subset.
Kaneda
Hideaki
H
The Center for Research in Cardiovascular Interventions, Stanford University, Stanford, California, USA.
Ako
Junya
J
Kataoka
Toru
T
Takahashi
Takefumi
T
Terashima
Mitsuyasu
M
Waseda
Katsuhisa
K
Miyazawa
Akiyoshi
A
Hassan
Ali
A
Honda
Yasuhiro
Y
Yock
Paul G
PG
Fitzgerald
Peter J
PJ
D000368:Aged; D015906:Angioplasty, Balloon, Coronary / Q000009:adverse effects; D023903:Coronary Restenosis / Q000000981:diagnostic imaging* / Q000209:etiology; D003331:Coronary Vessels / Q000000981:diagnostic imaging; D048909:Diabetes Complications; D005260:Female; D006801:Humans; D006965:Hyperplasia; D008297:Male; D008875:Middle Aged; D015607:Stents / Q000009:adverse effects*; D017539:Tunica Intima / Q000000981:diagnostic imaging* / Q000473:pathology; D018084:Ultrasonography, Interventional