Prediction of late restenosis after sirolimus-eluting stent implantation using serial quantitative angiographic and intr
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ORIGINAL ARTICLE
Prediction of late restenosis after sirolimus-eluting stent implantation using serial quantitative angiographic and intravascular ultrasound analysis Ryuichi Funada • Yuji Oikawa • Junji Yajima • Shunsuke Matsuno Hiroto Kano • Hajime Kirigaya • Kazuyuki Nagashima • Masahiko Kurabayashi • Tadanori Aizawa
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Received: 1 December 2009 / Accepted: 14 July 2010 / Published online: 11 August 2010 Ó Japanese Association of Cardiovascular Intervention and Therapeutics 2010
Abstract Although sirolimus-eluting stents (SESs) have shown to significantly reduce the incidence of restenosis, it remains unclear when the follow-up angiography should be performed after SES implantation. A total of 868 patients with 1,574 lesions were treated with SES. Of the 71 patients with 87 lesions were performed serial angiographic and intravascular ultrasound (IVUS) analysis (pre, post, 1st and 2nd-follow-up). The first follow-up period was 7.9 ± 3.5 months and the second follow-up was 18.9 ± 7.7 months. Late restenosis (LR) was defined as diameter stenosis C50% at second follow-up, which was \50% at first follow-up. A total of restenosis was documented in 69 patients with 89 lesions (5.7%) overall, 13 lesions (3.2%) led to LR. Angiographic pattern of LR was predominately focal pattern. In LR group, late lumen loss by angiography was increased between 1st-follow-up and 2nd-follow-up (0.69 ± 0.41 mm in first follow-up and 1.98 ± 0.44 mm in second follow-up, p \ 0.0001). Minimum lumen area (MLA) by IVUS had slightly decreased already in 1st-follow-up (6.07 ± 2.31 mm2 in post procedure and 4.71 ± 2.05 mm2 in 1st-follow-up, p = 0.098) and significantly decreased in 2nd-follow-up (6.07 ± 2.31 mm2 in post procedure and 1.71 ± 0.93 mm2 in 2ndfollow-up, p \ 0.0001). However, in each period, there were no significant difference in both late lumen loss and MLA in non-LR group. Neointima growth prolonged R. Funada (&) Y. Oikawa J. Yajima S. Matsuno H. Kano H. Kirigaya K. Nagashima T. Aizawa Department of Cardiology, The Cardiovascular Institute Hospital, 7-3-10 Roppongi Minato-ku, Tokyo 106-0032, Japan e-mail: [email protected] M. Kurabayashi Department of Medicine and Biological Science, Gunma University Graduate School of Medicine, Gunma, Japan
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gradually over 1 year in LR group. These findings suggest that if neointimal proliferation is recognized in short-termfollow-up period, long-follow-up should be needed. Keywords Late restenosis Sirolimus-eluting stent Intravascular ultrasound Late stent thrombosis Abbreviations LR Late restenosis MLA Minimum lumen area TLR Target lesion revascularization LST Late stent thrombosis
Introduction The previous studies have demonstrated that the use of drug-eluting stents (DES) has significantly reduced restenosis and the need for repeat revascularization compared with bare-metal stents [1–5]. However, concern exists that varying degrees of inflammation, representing delayed healing are usually observed in DES implanted patients [6] and this pathological findings ha
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