title: Outcome after acute incomplete sirolimus-eluting stent apposition as assessed by serial intravascular ultrasound.
abstract: We investigated the fate of postprocedural incomplete stent apposition (ISA) after sirolimus-eluting stent (SES) implantation by evaluating long-term intravascular ultrasound findings in 168 consecutive patients (182 de novo lesions). Postprocedural ISA was defined as > or = 1 stent strut that was clearly separated from the vessel wall with evidence of blood speckle behind the strut without overlapping a side branch. After SES implantation, there were 61 ISA sites in 46 stents in 31 patients (23 at the proximal edge, 7 at the distal edge, and 31 within the stent body). There were no clinical, procedural, or intravascular ultrasound measurement differences between patients and lesions with versus without ISA. At follow-up, 15 acute ISA sites (25%) in 11 patients completely resolved and 40 sites (75%) in 20 patients persisted, although 32 of 46 persisting ISA sites (70%) decreased. There was a greater decrease in effective lumen area and a greater increase in peristent plaque area in the complete-resolution group than in the persistent-ISA group. No lesion developed stent thrombosis or in-stent restenosis (angiographic diameter stenosis > 50%). Six acute ISA sites were also associated with new, late acquired ISA, only 1 of which resulted in aneurysm formation. Although most ISAs after SES implantation do not resolve completely, the incidence of restenosis or thrombosis is not affected.
authors.affiliation: The Columbia University Medical Center and Cardiovascular Research Foundation, New York, New York, USA.
authors.forename: Masashi
authors.initials: M
authors.lastname: Kimura
authors.forename: Gary S
authors.initials: GS
authors.lastname: Mintz
authors.forename: Stéphane
authors.initials: S
authors.lastname: Carlier
authors.forename: Hideo
authors.initials: H
authors.lastname: Takebayashi
authors.forename: Kenichi
authors.initials: K
authors.lastname: Fujii
authors.forename: Koichi
authors.initials: K
authors.lastname: Sano
authors.forename: Takenori
authors.initials: T
authors.lastname: Yasuda
authors.forename: Ricardo A
authors.initials: RA
authors.lastname: Costa
authors.forename: Jose R
authors.initials: JR
authors.lastname: Costa
authors.forename: Jie
authors.initials: J
authors.lastname: Quen
authors.forename: Kaoru
authors.initials: K
authors.lastname: Tanaka
authors.forename: Joanna
authors.initials: J
authors.lastname: Lui
authors.forename: Giora
authors.initials: G
authors.lastname: Weisz
authors.forename: Issam
authors.initials: I
authors.lastname: Moussa
authors.forename: George
authors.initials: G
authors.lastname: Dangas
authors.forename: Roxana
authors.initials: R
authors.lastname: Mehran
authors.forename: Alexandra J
authors.initials: AJ
authors.lastname: Lansky
authors.forename: Edward M
authors.initials: EM
authors.lastname: Kreps
authors.forename: Michael
authors.initials: M
authors.lastname: Collins
authors.forename: Gregg W
authors.initials: GW
authors.lastname: Stone
authors.forename: Jeffrey W
authors.initials: JW
authors.lastname: Moses
authors.forename: Martin B
authors.initials: MB
authors.lastname: Leon
mesh_terms: D000208:Acute Disease; D019917:Blood Vessel Prosthesis Implantation / Q000009:adverse effects* / Q000295:instrumentation; D020099:Coated Materials, Biocompatible; D023921:Coronary Stenosis / Q000000981:diagnostic imaging* / Q000601:surgery; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007166:Immunosuppressive Agents / Q000627:therapeutic use*; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications; D011475:Prosthesis Failure; D020123:Sirolimus / Q000627:therapeutic use*; D015607:Stents; D018084:Ultrasonography, Interventional / Q000379:methods*
chemical_list: D020099:Coated Materials, Biocompatible; D007166:Immunosuppressive Agents; D020123:Sirolimus