Treatment of Restenotic Drug-Eluting Stents: Ultrasound Analysis
Treatment of Restenotic Drug-Eluting Stents: Ultrasound Analysis
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 preand 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 preintervention to 4.6 ± 1.6 mm 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.
Sirolimus-eluting and paclitaxel-eluting stents decrease neointimal hyperplasia leading to a reduction, but not elimination, of in-stent restenosis. Because sirolimus and paclitaxel decrease neointimal hyperplasia, restenosis is dependent on final drug-eluting stent (DES) dimensions; an optimally expanded stent area assessed by intravascular ultrasound (IVUS) is a strong predictor of freedom from clinical, angiographic and IVUS restenosis after DES implantation. However, it is not possible to obtain an optimum stent area in all lesions, and it is not clear how underexpanded stent dimensions impact the outcome of a repeat intervention (i.e., an intervention to treat DES restenosis). Because there are only limited data on the treatment of DES restenosis, we evaluated the IVUS findings during repeat interventions for the treatment of DES restenosis.
Background and Introduction
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 preand 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 preintervention to 4.6 ± 1.6 mm 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.
Introduction
Sirolimus-eluting and paclitaxel-eluting stents decrease neointimal hyperplasia leading to a reduction, but not elimination, of in-stent restenosis. Because sirolimus and paclitaxel decrease neointimal hyperplasia, restenosis is dependent on final drug-eluting stent (DES) dimensions; an optimally expanded stent area assessed by intravascular ultrasound (IVUS) is a strong predictor of freedom from clinical, angiographic and IVUS restenosis after DES implantation. However, it is not possible to obtain an optimum stent area in all lesions, and it is not clear how underexpanded stent dimensions impact the outcome of a repeat intervention (i.e., an intervention to treat DES restenosis). Because there are only limited data on the treatment of DES restenosis, we evaluated the IVUS findings during repeat interventions for the treatment of DES restenosis.
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