Mechanisms and Patterns of Intravascular Ultrasound In-Stent Restenosis Among Bare Metal Stents and First- and Second-Generation Drug-Eluting Stents.
The most common causes of in-stent restenosis (ISR) are intimal hyperplasia and stent under expansion. The purpose of this study was to use intravascular ultrasound (IVUS) to compare the ISR mechanisms of bare metal stents (BMS), first-generation drug-eluting stents (DES), and second-generation DES. There were 298 ISR lesions including 52 BMS, 73 sirolimus-eluting stents, 52 paclitaxel-eluting stents, 16 zotarolimus-eluting stents, and 105 everolimus-eluting stent. Mean patient age was 66.6 ± 1.1 years, 74.2% were men, and 48.3% had diabetes mellitus. BMS restenosis presented later (70.0 ± 66.7 months) with more intimal hyperplasia compared with DES (BMS 58.6 ± 15.5%, first-generation DES 52.6 ± 20.9%, second-generation DES 48.2 ± 22.2%, p = 0.02). Although reference lumen areas were similar in BMS and first- and second-generation DES, restenotic DES were longer (BMS 21.8 ± 13.5 mm, first-generation DES 29.4 ± 16.1 mm, second-generation DES 32.1 ± 18.7 mm, p = 0.003), and stent areas were smaller (BMS 7.2 ± 2.4 mm(2), first-generation DES 6.1 ± 2.1 mm(2), second-generation DES 5.7 ± 2.0 mm(2), p <0.001). Stent fracture was seen only in DES (first-generation DES 7 [5.0%], second-generation DES 8 [7.4%], p = 0.13). In conclusion, restenotic first- and second-generation DES were characterized by less neointimal hyperplasia, smaller stent areas, longer stent lengths, and more stent fractures than restenotic BMS.
Cardiovascular Research Foundation, New York, New York; Columbia University Medical Center, New York, New York.
Kosaku
K
Goto
Cardiovascular Research Foundation, New York, New York; Columbia University Medical Center, New York, New York.
Zhijing
Z
Zhao
Cardiovascular Research Foundation, New York, New York.
Mitsuaki
M
Matsumura
Cardiovascular Research Foundation, New York, New York; Columbia University Medical Center, New York, New York.
Tomotaka
T
Dohi
Cardiovascular Research Foundation, New York, New York.
Nobuaki
N
Kobayashi
Cardiovascular Research Foundation, New York, New York; Columbia University Medical Center, New York, New York.
Ajay J
AJ
Kirtane
Columbia University Medical Center, New York, New York.
LeRoy E
LE
Rabbani
Columbia University Medical Center, New York, New York.
Michael B
MB
Collins
Cardiovascular Research Foundation, New York, New York; Columbia University Medical Center, New York, New York.
Manish A
MA
Parikh
Cardiovascular Research Foundation, New York, New York; Columbia University Medical Center, New York, New York.
Susheel K
SK
Kodali
Cardiovascular Research Foundation, New York, New York; Columbia University Medical Center, New York, New York.
Martin B
MB
Leon
Columbia University Medical Center, New York, New York.
Jeffrey W
JW
Moses
Cardiovascular Research Foundation, New York, New York.
Gary S
GS
Mintz
Cardiovascular Research Foundation, New York, New York; Columbia University Medical Center, New York, New York. Electronic address: amaehara@crf.org.
Akiko
A
Maehara
D000368:Aged; D023903:Coronary Restenosis / Q000000981:diagnostic imaging* / Q000517:prevention & control / Q000601:surgery*; D054855:Drug-Eluting Stents / Q000009:adverse effects; D000068338:Everolimus; D005260:Female; D006801:Humans; D007166:Immunosuppressive Agents; D008297:Male; D008670:Metals; D008875:Middle Aged; D058426:Neointima / Q000000981:diagnostic imaging; D017239:Paclitaxel; D062645:Percutaneous Coronary Intervention; D011474:Prosthesis Design; D012189:Retrospective Studies; D012307:Risk Factors; D020123:Sirolimus / Q000031:analogs & derivatives; D015607:Stents / Q000009:adverse effects; D013997:Time Factors; D016896:Treatment Outcome; D018084:Ultrasonography, Interventional
D007166:Immunosuppressive Agents; D008670:Metals; D000068338:Everolimus; C489443:zotarolimus; D017239:Paclitaxel; D020123:Sirolimus