Treatment of restenotic drug-eluting stents: an intravascular ultrasound analysis.
BACKGROUND
The intravascular ultrasound (IVUS) findings during repeat intervention for drug-eluting stent (DES) restenosis have not been well described.


METHODS
We identified 62 consecutive DES restenosis lesions (45 sirolimus-eluting stents and 17 paclitaxel-eluting stents) undergoing repeat intervention with pre and postintervention IVUS. Lumen, stent and intimal hyperplasia (stent minus lumen) areas were measured at the minimal lumen area (MLA) site and minimal stent area (MSA) site.


RESULTS
Repeat stent implantation was performed in 55 lesions (88.7%). Overall, MLA increased from 2.3 +/- 0.7 mm(2) preintervention to 4.6 +/- 1.6 mm(2) postintervention. Preintervention MLA was seen at exactly the preintervention MSA site in 42%, while 73% of postintervention MLAs were located at the preintervention MSA site. There was a strong correlation between the preintervention MSA and the postintervention MLA (r = 0.79; p < 0.001). Preintervention MSA was the strongest independent predictor of a larger postintervention MLA (coefficient 0.72; p < 0.001).


CONCLUSIONS
The preintervention MSA was a major predictor of larger lumen area after repeat intervention for DES restenosis. Several IVUS studies have shown that stent dimensions do not change over time. Therefore, the MSA of the original stent implantation procedure still has the greatest impact on subsequent interventions to treat DES restenosis.
Sano
Koichi
K
Cardiovascular Research Foundation, 611 Pennsylvania Avenue, S.E., No.386, Washington, D.C., USA.
Mintz
Gary S
GS
Carlier
Stephane G
SG
Solinas
Emilia
E
Costa
Jose de Ribamar
Jde R
Qian
Jie
J
Missel
Eduardo
E
Shan
Shoujie
S
Franklin-Bond
Theresa
T
Boland
Paul
P
Weisz
Giora
G
Moussa
Issam
I
Dangas
George
G
Mehran
Roxana
R
Lansky
Alexandra J
AJ
Kreps
Edward
E
Collins
Michael
M
Stone
Gregg W
GW
Moses
Jeffrey W
JW
Leon
Martin B
MB
D000368:Aged; D015906:Angioplasty, Balloon, Coronary; D000972:Antineoplastic Agents, Phytogenic / Q000008:administration & dosage; D017023:Coronary Angiography; D023903:Coronary Restenosis / Q000000981:diagnostic imaging* / Q000628:therapy*; D054855:Drug-Eluting Stents; D005260:Female; D006801:Humans; D007166:Immunosuppressive Agents / Q000008:administration & dosage; D008297:Male; D008875:Middle Aged; D017239:Paclitaxel / Q000008:administration & dosage; D020123:Sirolimus / Q000008:administration & dosage; D018084:Ultrasonography, Interventional
D000972:Antineoplastic Agents, Phytogenic; D007166:Immunosuppressive Agents; D017239:Paclitaxel; D020123:Sirolimus