title: Impact of hinge motion on in-stent restenosis after sirolimus-eluting stent implantation.
abstract: BACKGROUND
  A tortuous lesion with hinge motion is reportedly a risk factor for in-stent restenosis (ISR) after bare metal stent implantation. Sirolimus-eluting stents (SESs) implantation has dramatically reduced ISR. However, SES is a closed-cell design stent, which has low conformability and flexibility. Several studies have reported a relationship between tortuous lesions and stent fracture, which is one of the causes of ISR. The efficacy of SES in a tortuous lesion with hinge motion has not been fully evaluated. The aim of this study was to investigate the relationship between tortuous lesions and ISR after SES implantation.
  
  
  RESULTS
  Three year clinical follow-up data after SES implantation, including 6-9 month scheduled follow-up coronary angiography in 399 consecutive patients with 537 lesions, were obtained. Δangle was defined as the difference in the angle of the target lesion between the diastole and systole before the procedure. The incidence of ISR was 8.2%. The mean maximal angle and Δangle were larger in the ISR group (47 ± 22° vs. 37 ± 21°, P=0.004 and 20 ± 13° vs. 13 ± 10°, P < 0.0001, respectively). Independent predictors of ISR were Δangle, hemodialysis, aortic ostium stenting, and diabetes mellitus. Hinge motion-associated ISR (Δangle ≥ 16°) occurred in 28 lesions: stent fracture in 9, stent recoil in 6, edge injury in 10, and others in 3.
  
  
  CONCLUSIONS
  The amount of hinge motion in tortuous lesions should be considered in the selection of drug eluting stent types.
authors.affiliation: Department of Cardiovascular Medicine, Wakayama Medical University, Wakayama, Japan.
authors.forename: Yasushi
authors.initials: Y
authors.lastname: Ino
authors.forename: Takashi
authors.initials: T
authors.lastname: Kubo
authors.forename: Hironori
authors.initials: H
authors.lastname: Kitabata
authors.forename: Kunihiro
authors.initials: K
authors.lastname: Shimamura
authors.forename: Yasutsugu
authors.initials: Y
authors.lastname: Shiono
authors.forename: Makoto
authors.initials: M
authors.lastname: Orii
authors.forename: Keishi
authors.initials: K
authors.lastname: Okochi
authors.forename: Hiromichi
authors.initials: H
authors.lastname: Sougawa
authors.forename: Takashi
authors.initials: T
authors.lastname: Tanimoto
authors.forename: Kenichi
authors.initials: K
authors.lastname: Komukai
authors.forename: Kohei
authors.initials: K
authors.lastname: Ishibashi
authors.forename: Shigeho
authors.initials: S
authors.lastname: Takarada
authors.forename: Hiroko
authors.initials: H
authors.lastname: Nakanishi
authors.forename: Atsushi
authors.initials: A
authors.lastname: Tanaka
authors.forename: Keizo
authors.initials: K
authors.lastname: Kimura
authors.forename: Kumiko
authors.initials: K
authors.lastname: Hirata
authors.forename: Masato
authors.initials: M
authors.lastname: Mizukoshi
authors.forename: Toshio
authors.initials: T
authors.lastname: Imanishi
authors.forename: Takashi
authors.initials: T
authors.lastname: Akasaka
mesh_terms: D000368:Aged; D048909:Diabetes Complications / Q000453:epidemiology / Q000473:pathology; D054855:Drug-Eluting Stents; D005260:Female; D005500:Follow-Up Studies; D006083:Graft Occlusion, Vascular / Q000453:epidemiology* / Q000209:etiology* / Q000473:pathology*; D006801:Humans; D008297:Male; D008875:Middle Aged; D009038:Motion; D006435:Renal Dialysis / Q000009:adverse effects; D012307:Risk Factors