Neointimal progression and luminal narrowing in sirolimus-eluting stent treatment for bare metal in-stent restenosis: A quantitative intravascular ultrasound analysis

Ryota Sakurai, Junya Ako, Ali H M Hassan, Heidi N. Bonneau, Franz Josef Neumann, Walter Desmet, David Holmes, Paul G. Yock, Peter J. Fitzgerald, Yasuhiro Honda

Research output: Contribution to journalArticle

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Abstract

Background: Recurrent restenosis may occur after drug-eluting stent implantation for in-stent restenosis (ISR) of bare metal stents (BMSs), especially in areas involving drug-eluting stent gaps. Methods: To investigate the details of neointimal progression and luminal narrowing after the treatment of ISR using sirolimus-eluting stents (SESs), serial intravascular ultrasound analysis was performed in 65 patients with ISR at postintervention and at 6-month follow-up. The total stented segment was categorized into 3 compartments: new SES (N), new SES and old BMS overlap (N/O), and old BMS (O). In each of the 190 compartments, serial intravascular ultrasound parameters were analyzed at the cross section of the maximum change in neointimal area (Δneointimal area) from postintervention to follow-up or the minimum lumen area at follow-up if Δneointimal area was 0. Minimum lumen area in each compartment was also investigated serially. Results: At postintervention, lumen area was the smallest in compartment N/O (N 5.8 ± 1.5, N/O 5.1 ± 1.3, O 6.0 ± 1.4 mm2, P = .005). Not only the average of maximum Δneointimal area (N 0.2 ± 0.4, N/O 0.2 ± 0.4, O 0.8 ± 1.0 mm2, P < .0001) but also the frequency of minimum lumen area decreasing from ≥4.0 mm2 at postintervention to <4.0 mm2 at follow-up (N 4.0%, N/O 5.1%, O 23.5%, P = .012) was the largest in compartment O. Conclusions: Neointimal progression and consequent luminal narrowing tend to occur where BMS is uncovered with SES in treatment of ISR, even in the absence of an obvious stenosis at postintervention.

Original languageEnglish (US)
Pages (from-to)361-365
Number of pages5
JournalAmerican Heart Journal
Volume154
Issue number2
DOIs
StatePublished - Aug 1 2007

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Sirolimus
Stents
Metals
Therapeutics
Drug-Eluting Stents
Pathologic Constriction

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine

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Neointimal progression and luminal narrowing in sirolimus-eluting stent treatment for bare metal in-stent restenosis : A quantitative intravascular ultrasound analysis. / Sakurai, Ryota; Ako, Junya; Hassan, Ali H M; Bonneau, Heidi N.; Neumann, Franz Josef; Desmet, Walter; Holmes, David; Yock, Paul G.; Fitzgerald, Peter J.; Honda, Yasuhiro.

In: American Heart Journal, Vol. 154, No. 2, 01.08.2007, p. 361-365.

Research output: Contribution to journalArticle

Sakurai, Ryota ; Ako, Junya ; Hassan, Ali H M ; Bonneau, Heidi N. ; Neumann, Franz Josef ; Desmet, Walter ; Holmes, David ; Yock, Paul G. ; Fitzgerald, Peter J. ; Honda, Yasuhiro. / Neointimal progression and luminal narrowing in sirolimus-eluting stent treatment for bare metal in-stent restenosis : A quantitative intravascular ultrasound analysis. In: American Heart Journal. 2007 ; Vol. 154, No. 2. pp. 361-365.
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abstract = "Background: Recurrent restenosis may occur after drug-eluting stent implantation for in-stent restenosis (ISR) of bare metal stents (BMSs), especially in areas involving drug-eluting stent gaps. Methods: To investigate the details of neointimal progression and luminal narrowing after the treatment of ISR using sirolimus-eluting stents (SESs), serial intravascular ultrasound analysis was performed in 65 patients with ISR at postintervention and at 6-month follow-up. The total stented segment was categorized into 3 compartments: new SES (N), new SES and old BMS overlap (N/O), and old BMS (O). In each of the 190 compartments, serial intravascular ultrasound parameters were analyzed at the cross section of the maximum change in neointimal area (Δneointimal area) from postintervention to follow-up or the minimum lumen area at follow-up if Δneointimal area was 0. Minimum lumen area in each compartment was also investigated serially. Results: At postintervention, lumen area was the smallest in compartment N/O (N 5.8 ± 1.5, N/O 5.1 ± 1.3, O 6.0 ± 1.4 mm2, P = .005). Not only the average of maximum Δneointimal area (N 0.2 ± 0.4, N/O 0.2 ± 0.4, O 0.8 ± 1.0 mm2, P < .0001) but also the frequency of minimum lumen area decreasing from ≥4.0 mm2 at postintervention to <4.0 mm2 at follow-up (N 4.0{\%}, N/O 5.1{\%}, O 23.5{\%}, P = .012) was the largest in compartment O. Conclusions: Neointimal progression and consequent luminal narrowing tend to occur where BMS is uncovered with SES in treatment of ISR, even in the absence of an obvious stenosis at postintervention.",
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T1 - Neointimal progression and luminal narrowing in sirolimus-eluting stent treatment for bare metal in-stent restenosis

T2 - A quantitative intravascular ultrasound analysis

AU - Sakurai, Ryota

AU - Ako, Junya

AU - Hassan, Ali H M

AU - Bonneau, Heidi N.

AU - Neumann, Franz Josef

AU - Desmet, Walter

AU - Holmes, David

AU - Yock, Paul G.

AU - Fitzgerald, Peter J.

AU - Honda, Yasuhiro

PY - 2007/8/1

Y1 - 2007/8/1

N2 - Background: Recurrent restenosis may occur after drug-eluting stent implantation for in-stent restenosis (ISR) of bare metal stents (BMSs), especially in areas involving drug-eluting stent gaps. Methods: To investigate the details of neointimal progression and luminal narrowing after the treatment of ISR using sirolimus-eluting stents (SESs), serial intravascular ultrasound analysis was performed in 65 patients with ISR at postintervention and at 6-month follow-up. The total stented segment was categorized into 3 compartments: new SES (N), new SES and old BMS overlap (N/O), and old BMS (O). In each of the 190 compartments, serial intravascular ultrasound parameters were analyzed at the cross section of the maximum change in neointimal area (Δneointimal area) from postintervention to follow-up or the minimum lumen area at follow-up if Δneointimal area was 0. Minimum lumen area in each compartment was also investigated serially. Results: At postintervention, lumen area was the smallest in compartment N/O (N 5.8 ± 1.5, N/O 5.1 ± 1.3, O 6.0 ± 1.4 mm2, P = .005). Not only the average of maximum Δneointimal area (N 0.2 ± 0.4, N/O 0.2 ± 0.4, O 0.8 ± 1.0 mm2, P < .0001) but also the frequency of minimum lumen area decreasing from ≥4.0 mm2 at postintervention to <4.0 mm2 at follow-up (N 4.0%, N/O 5.1%, O 23.5%, P = .012) was the largest in compartment O. Conclusions: Neointimal progression and consequent luminal narrowing tend to occur where BMS is uncovered with SES in treatment of ISR, even in the absence of an obvious stenosis at postintervention.

AB - Background: Recurrent restenosis may occur after drug-eluting stent implantation for in-stent restenosis (ISR) of bare metal stents (BMSs), especially in areas involving drug-eluting stent gaps. Methods: To investigate the details of neointimal progression and luminal narrowing after the treatment of ISR using sirolimus-eluting stents (SESs), serial intravascular ultrasound analysis was performed in 65 patients with ISR at postintervention and at 6-month follow-up. The total stented segment was categorized into 3 compartments: new SES (N), new SES and old BMS overlap (N/O), and old BMS (O). In each of the 190 compartments, serial intravascular ultrasound parameters were analyzed at the cross section of the maximum change in neointimal area (Δneointimal area) from postintervention to follow-up or the minimum lumen area at follow-up if Δneointimal area was 0. Minimum lumen area in each compartment was also investigated serially. Results: At postintervention, lumen area was the smallest in compartment N/O (N 5.8 ± 1.5, N/O 5.1 ± 1.3, O 6.0 ± 1.4 mm2, P = .005). Not only the average of maximum Δneointimal area (N 0.2 ± 0.4, N/O 0.2 ± 0.4, O 0.8 ± 1.0 mm2, P < .0001) but also the frequency of minimum lumen area decreasing from ≥4.0 mm2 at postintervention to <4.0 mm2 at follow-up (N 4.0%, N/O 5.1%, O 23.5%, P = .012) was the largest in compartment O. Conclusions: Neointimal progression and consequent luminal narrowing tend to occur where BMS is uncovered with SES in treatment of ISR, even in the absence of an obvious stenosis at postintervention.

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