title: Volumetric intravascular ultrasound assessment of neointimal hyperplasia and nonuniform stent strut distribution in sirolimus-eluting stent restenosis.
abstract: 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.
authors.affiliation: Columbia University Medical Center and Cardiovascular Research Foundation, New York, NY, USA.
authors.forename: Koichi
authors.initials: K
authors.lastname: Sano
authors.forename: Gary S
authors.initials: GS
authors.lastname: Mintz
authors.forename: Stéphane G
authors.initials: SG
authors.lastname: Carlier
authors.forename: Kenichi
authors.initials: K
authors.lastname: Fujii
authors.forename: Hideo
authors.initials: H
authors.lastname: Takebayashi
authors.forename: Masashi
authors.initials: M
authors.lastname: Kimura
authors.forename: Jose Ribamar
authors.initials: JR
authors.lastname: Costa
authors.forename: Kaoru
authors.initials: K
authors.lastname: Tanaka
authors.forename: Ricardo A
authors.initials: RA
authors.lastname: Costa
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 D
authors.initials: GD
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: 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
chemical_list: D020123:Sirolimus