title: Intravascular ultrasound comparison of sirolimus-eluting stent versus bare metal stent implantation in diseased saphenous vein grafts (from the RRISC [Reduction of Restenosis In Saphenous Vein Grafts With Cypher Sirolimus-Eluting Stent] trial).
abstract: The randomized Reduction of Restenosis In Saphenous Vein Grafts with Cypher Sirolimus-Eluting Stent trial compared angiographic outcomes of sirolimus-eluting stents (SESs) versus bare metal stents (BMSs) in saphenous vein grafts (SVG). Using intravascular ultrasound (IVUS) performed during 6-month follow-up angiography, we compared the vascular effects of the 2 types of stent on SVGs. Of 75 patients (96 lesions) included, 59 patients underwent IVUS in 61 SVGs; 29 patients received 40 SESs for 34 lesions, and 30 patients received 42 BMSs for 39 lesions. IVUS parameters (diameters, areas, and volumes) were compared in the 2 groups. A specific analysis was performed for overlapping SESs. Median neointimal volume was 1.3 mm(3) (interquartile range 0 to 13.1) in SESs versus 24.5 (7.8 to 39.5) in BMSs (p <0.001). Minimal incomplete stent apposition was detected at only 3 stent edges (2 BMSs, 1 SES) next to ectatic regions of the SVG. Compared with single SESs, overlapping SESs showed significant increases in neointimal reaction, with a neointimal volume of 0.6 mm(3)/mm of stent (0.1 to 1.8) versus 0 (0 to 0.4) in single SESs (p = 0.03), and this phenomenon was mainly localized in overlapping SES segments, where neointimal volume per millimeter of stent was 1.1 mm(3)/mm (0.6 to 4.4) versus 0 (0 to 1.3) in nonoverlapping segments (p = 0.05). In conclusion, SESs effectively inhibit neointimal hyperplasia volume compared with BMSs in diseased vein grafts, without evidence of increased incomplete apposition risk. The neointimal response to overlapping SES layers seems higher than to a single SES layer.
authors.affiliation: Antwerp Cardiovascular Institute Middelheim, AZ Middelheim, Antwerp, Belgium. agostonipf@gmail.com
authors.forename: Pierfrancesco
authors.initials: P
authors.lastname: Agostoni
authors.forename: Paul
authors.initials: P
authors.lastname: Vermeersch
authors.forename: Oscar
authors.initials: O
authors.lastname: Semeraro
authors.forename: Stefan
authors.initials: S
authors.lastname: Verheye
authors.forename: Glenn
authors.initials: G
authors.lastname: Van Langenhove
authors.forename: Paul
authors.initials: P
authors.lastname: Van den Heuvel
authors.forename: Carl
authors.initials: C
authors.lastname: Convens
authors.forename: Frank
authors.initials: F
authors.lastname: Van den Branden
authors.forename: Nico
authors.initials: N
authors.lastname: Bruining
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D017023:Coronary Angiography; D001026:Coronary Artery Bypass; D003324:Coronary Artery Disease / Q000601:surgery / Q000628:therapy*; D004311:Double-Blind Method; D016503:Drug Delivery Systems; D005260:Female; D006083:Graft Occlusion, Vascular / Q000188:drug therapy* / Q000628:therapy; D006801:Humans; D007166:Immunosuppressive Agents / Q000008:administration & dosage*; D008297:Male; D012501:Saphenous Vein / Q000000981:diagnostic imaging* / Q000637:transplantation; D020123:Sirolimus / Q000008:administration & dosage*; D015607:Stents; D016896:Treatment Outcome; D018084:Ultrasonography, Interventional / Q000379:methods
chemical_list: D007166:Immunosuppressive Agents; D020123:Sirolimus