title: Serial angiographic and intravascular ultrasound evaluation to interrogate the presence of late "catch-up" phenomenon after Cypher® sirolimus-eluting stent implantation.
abstract: Despite the expressive reduction in the intimal hyperplasia (IH) formation after DES implantation at the mid-term, late restenosis has been recently noticed. Our objective was to determine, by means of serial angiography (QCA) and intravascular ultrasound (IVUS) at two different time points, whether the occurrence of the "late catch-up" phenomenon occurs after sirolimus-eluting stent (SES) implantation. Thirty-eight non-complex patients treated with a single 18-mm SES who had systematic serial QCA and IVUS analyses at mean 8 and 20 months were enrolled. Primary endpoint is to evaluate the temporal course of IH formation after SES implantation, by comparing QCA in-stent late loss and IVUS percent IH obstruction between the invasive follow-ups. Mean cohort age was 59.3 years and 31.6% were diabetics. Baseline reference vessel diameter was 2.8 ± 0.4 mm and lesion length was 11.5 ± 3.5 mm. Left anterior descending artery was the most frequent target vessel (55.3%). Between 8 and 20 months, a non-significant increase in in-stent late loss from 0.10 ± 0.18 to 0.15 ± 0.30 mm (P = 0.38) was observed. By IVUS, a slight increase in the percent IH obstruction (1.03 ± 2.13 to 1.76 ± 1.87%, P = 0.12) was detected between the two evaluations. Interestingly, all the neoformed tissue accrued from 8 to 20 months accumulated in the distal portion of the stent. In the non-complex scenario, SES implantation was associated with a minimal, non-significant increase in the IH volume between 8 and 20 months.
authors.affiliation: Instituto Dante Pazzanese de Cardiologia, Av. Dr. Dante Pazzanese, 500, Ibirapuera, 04012-180, São Paulo, SP, Brazil.
authors.forename: Daniel
authors.initials: D
authors.lastname: Chamié
authors.forename: Alexandre
authors.initials: A
authors.lastname: Abizaid
authors.forename: J Ribamar
authors.initials: JR
authors.lastname: Costa
authors.forename: Fausto
authors.initials: F
authors.lastname: Feres
authors.forename: J Fábio
authors.initials: JF
authors.lastname: Almiro da Silva
authors.forename: Luiz Alberto P
authors.initials: LA
authors.lastname: Mattos
authors.forename: Rodolfo
authors.initials: R
authors.lastname: Staico
authors.forename: Ricardo A
authors.initials: RA
authors.lastname: Costa
authors.forename: Andréa
authors.initials: A
authors.lastname: Abizaid
authors.forename: Luiz Fernando L
authors.initials: LF
authors.lastname: Tanajura
authors.forename: Amanda G M R
authors.initials: AG
authors.lastname: Sousa
authors.forename: J Eduardo
authors.initials: JE
authors.lastname: Sousa
mesh_terms: D000368:Aged; D000704:Analysis of Variance; D015906:Angioplasty, Balloon, Coronary / Q000009:adverse effects / Q000295:instrumentation*; D001938:Brazil; D002317:Cardiovascular Agents / Q000008:administration & dosage*; D016009:Chi-Square Distribution; D017023:Coronary Angiography / Q000379:methods*; D003324:Coronary Artery Disease / Q000000981:diagnostic imaging / Q000628:therapy*; D023903:Coronary Restenosis / Q000175:diagnosis* / Q000000981:diagnostic imaging / Q000209:etiology; D054855:Drug-Eluting Stents; D005260:Female; D006801:Humans; D006965:Hyperplasia; D008297:Male; D008875:Middle Aged; D011237:Predictive Value of Tests; D011474:Prosthesis Design; D018570:Risk Assessment; D012307:Risk Factors; D020123:Sirolimus / Q000008:administration & dosage*; D013997:Time Factors; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome; D018084:Ultrasonography, Interventional
chemical_list: D002317:Cardiovascular Agents; D020123:Sirolimus