title: Neointimal progression and luminal narrowing in sirolimus-eluting stent treatment for bare metal in-stent restenosis: a quantitative intravascular ultrasound analysis.
abstract: 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.
authors.affiliation: Center for Cardiovascular Technology, Stanford University Medical Center, Stanford, CA 94305-5637, USA.
authors.forename: Ryota
authors.initials: R
authors.lastname: Sakurai
authors.forename: Junya
authors.initials: J
authors.lastname: Ako
authors.forename: Ali H M
authors.initials: AH
authors.lastname: Hassan
authors.forename: Heidi N
authors.initials: HN
authors.lastname: Bonneau
authors.forename: Franz-Josef
authors.initials: FJ
authors.lastname: Neumann
authors.forename: Walter
authors.initials: W
authors.lastname: Desmet
authors.forename: David R
authors.initials: DR
authors.lastname: Holmes
authors.forename: Paul G
authors.initials: PG
authors.lastname: Yock
authors.forename: Peter J
authors.initials: PJ
authors.lastname: Fitzgerald
authors.forename: Yasuhiro
authors.initials: Y
authors.lastname: Honda
mesh_terms: 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
chemical_list: D007166:Immunosuppressive Agents; D020123:Sirolimus