Angiographic patterns of restenosis after percutaneous intervention of chronic total occlusive lesions with drug-eluting stents.
BACKGROUND
Although the success rate of percutaneous coronary intervention (PCI) of chronic total occlusive (CTO) lesions is rising recently, the nature and behavior of these revascularized lesions in the real-world practice are unknown.


METHODS
Data was collected from a prospective cohort of patients with successfully revascularized CTO lesions using drug-eluting stent (DES). Among these, patients with angiographical in-stent restenosis (ISR) were analyzed.


RESULTS
58% (n=149) of the total patients (n=255) with successful PCI of CTO received 6-9 months' angiographical follow-up. Angiographic ISR was identified in 36 lesions from 36 patients. There was a strong tendency towards diffuse ISR (61% of total ISR lesions) in these lesions, as compared with ISR after implantation of DES for non-CTO lesion in previous literatures. Multivariate analysis showed that post-procedural minimal lumen diameter (MLD) and total stent length were the only reliable predictors of diffuse ISR (HR 0.527 per 0.5 mm increment of MLD, HR 1.262 per 10mm increment of stent length). Compared with the group with larger post-procedural MLD (> 1.9 mm) and shorter stent length (≤ 55 mm), the group with smaller post-procedural MLD (≤ 1.9 mm) and longer stent length (> 55 mm) carried a 9-fold higher risk of diffuse restenosis. In addition, diffuse ISR was more frequently associated with symptoms or signs of myocardial ischemia.


CONCLUSIONS
Revascularized CTO lesions using DES may carry a high risk of diffuse ISR, which is associated with more frequent myocardial ischemia compared with focal ISR. Post-procedural MLD and total stent length are significant predictors of these types of ISR after successful CTO intervention.
Cardiovascular Center, Seoul National University Hospital, Republic of Korea.
Seung-Pyo
SP
Lee
Dong-Ho
DH
Shin
Kyung Woo
KW
Park
Hyun-Jae
HJ
Kang
Bon-Kwon
BK
Koo
Young-Seok
YS
Cho
Tae-Jin
TJ
Yeon
In-Ho
IH
Chae
Dong-Ju
DJ
Choi
Hyo-Soo
HS
Kim
D000368:Aged; D015906:Angioplasty, Balloon, Coronary / Q000009:adverse effects* / Q000295:instrumentation / Q000639:trends; D002908:Chronic Disease; D015331:Cohort Studies; D017023:Coronary Angiography / Q000639:trends; D054059:Coronary Occlusion / Q000000981:diagnostic imaging* / Q000601:surgery*; D023903:Coronary Restenosis / Q000000981:diagnostic imaging* / Q000209:etiology; D054855:Drug-Eluting Stents / Q000009:adverse effects*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D016896:Treatment Outcome