Neointimal progression and luminal narrowing in sirolimus-eluting stent treatment for bare metal in-stent restenosis: a quantitative intravascular ultrasound analysis.
BACKGROUND
Recurrent restenosis may occur after drug-eluting stent implantation for in-stent restenosis (ISR) of bare metal stents (BMSs), especially in areas involving drug-eluting stent gaps.


METHODS
To investigate the details of neointimal progression and luminal narrowing after the treatment of ISR using sirolimus-eluting stents (SESs), serial intravascular ultrasound analysis was performed in 65 patients with ISR at postintervention and at 6-month follow-up. The total stented segment was categorized into 3 compartments: new SES (N), new SES and old BMS overlap (N/O), and old BMS (O). In each of the 190 compartments, serial intravascular ultrasound parameters were analyzed at the cross section of the maximum change in neointimal area (delta neointimal area) from postintervention to follow-up or the minimum lumen area at follow-up if delta neointimal area was 0. Minimum lumen area in each compartment was also investigated serially.


RESULTS
At postintervention, lumen area was the smallest in compartment N/O (N 5.8 +/- 1.5, N/O 5.1 +/- 1.3, O 6.0 +/- 1.4 mm2, P = .005). Not only the average of maximum delta neointimal area (N 0.2 +/- 0.4, N/O 0.2 +/- 0.4, O 0.8 +/- 1.0 mm2, P < .0001) but also the frequency of minimum lumen area decreasing from > or = 4.0 mm2 at postintervention to < 4.0 mm2 at follow-up (N 4.0%, N/O 5.1%, O 23.5%, P = .012) was the largest in compartment O.


CONCLUSIONS
Neointimal progression and consequent luminal narrowing tend to occur where BMS is uncovered with SES in treatment of ISR, even in the absence of an obvious stenosis at postintervention.
Sakurai
Ryota
R
Center for Cardiovascular Technology, Stanford University Medical Center, Stanford, CA 94305-5637, USA.
Ako
Junya
J
Hassan
Ali H M
AH
Bonneau
Heidi N
HN
Neumann
Franz-Josef
FJ
Desmet
Walter
W
Holmes
David R
DR
Yock
Paul G
PG
Fitzgerald
Peter J
PJ
Honda
Yasuhiro
Y
D000368:Aged; D019412:Anatomy, Cross-Sectional; D023903:Coronary Restenosis / Q000000981:diagnostic imaging* / Q000188:drug therapy*; D018450:Disease Progression; D016503:Drug Delivery Systems; D005260:Female; D006801:Humans; D007166:Immunosuppressive Agents / Q000008:administration & dosage*; D008297:Male; D008875:Middle Aged; D020123:Sirolimus / Q000008:administration & dosage*; D015607:Stents; D017539:Tunica Intima / Q000000981:diagnostic imaging*; D018084:Ultrasonography, Interventional
D007166:Immunosuppressive Agents; D020123:Sirolimus