Outcome after acute incomplete sirolimus-eluting stent apposition as assessed by serial intravascular ultrasound.
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.
Kimura
Masashi
M
The Columbia University Medical Center and Cardiovascular Research Foundation, New York, New York, USA.
Mintz
Gary S
GS
Carlier
Stéphane
S
Takebayashi
Hideo
H
Fujii
Kenichi
K
Sano
Koichi
K
Yasuda
Takenori
T
Costa
Ricardo A
RA
Costa
Jose R
JR
Quen
Jie
J
Tanaka
Kaoru
K
Lui
Joanna
J
Weisz
Giora
G
Moussa
Issam
I
Dangas
George
G
Mehran
Roxana
R
Lansky
Alexandra J
AJ
Kreps
Edward M
EM
Collins
Michael
M
Stone
Gregg W
GW
Moses
Jeffrey W
JW
Leon
Martin B
MB
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*
D020099:Coated Materials, Biocompatible; D007166:Immunosuppressive Agents; D020123:Sirolimus