Volumetric intravascular ultrasound assessment of neointimal hyperplasia and nonuniform stent strut distribution in sirolimus-eluting stent restenosis.
The neointimal hyperplasia (IH) distribution pattern of in-stent restenotic lesions after sirolimus-eluting stent (SES) implantation has not been well described. We identified 48 in-stent restenotic lesions (41 patients) after SES implantation and performed volumetric intravascular ultrasound analyses. Lumen area, stent area, and IH area at the minimal lumen area site were 2.7 +/- 1.0, 5.4 +/- 1.9, and 2.7 +/- 1.4 mm(2), respectively. IH area at the minimal lumen site was larger in the group with a stent area > or =5.0 mm(2) than the group with a stent area <5.0 mm(2) (3.7 +/- 1.3 vs 1.9 +/- 0.8 mm(2), p <0.001). There were fewer visualized stent struts in lesions with a minimum stent area > or =5.0 mm(2) at the minimum lumen site compared with those with a stent area <5.0 mm(2) (0.69 +/- 0.25 vs 0.83 +/- 0.16, p = 0.04). When we compared lesions in patients with diabetes mellitus with patients without diabetes, minimum lumen areas, percent IH at minimal lumen area, percent IH, and neointima-free stent length were identical. In conclusion, (1) lesions without SES underexpansion at the minimum lumen site had more IH and greater nonuniform stent strut distribution compared with restenotic SESs that were underexpanded, and (2) the IH response did not appear to be more aggressive in patients with diabetes mellitus than in those without diabetes mellitus.
Sano
Koichi
K
Columbia University Medical Center and Cardiovascular Research Foundation, New York, NY, USA.
Mintz
Gary S
GS
Carlier
Stéphane G
SG
Fujii
Kenichi
K
Takebayashi
Hideo
H
Kimura
Masashi
M
Costa
Jose Ribamar
JR
Tanaka
Kaoru
K
Costa
Ricardo A
RA
Lui
Joanna
J
Weisz
Giora
G
Moussa
Issam
I
Dangas
George D
GD
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
D000368:Aged; D023903:Coronary Restenosis / Q000150:complications / Q000000981:diagnostic imaging*; D003331:Coronary Vessels / Q000000981:diagnostic imaging*; D048909:Diabetes Complications / Q000000981:diagnostic imaging; D005260:Female; D006801:Humans; D006965:Hyperplasia; D008297:Male; D020123:Sirolimus / Q000008:administration & dosage*; D015607:Stents; D017539:Tunica Intima / Q000000981:diagnostic imaging*; D018084:Ultrasonography, Interventional
D020123:Sirolimus