Angiographic Patterns of In-Stent Restenosis

Mehran, Roxana; Dangas, George; Abizaid, Andréa S.; Mintz, Gary S.; Lansky, Alexandra J.; Satler, Lowell F.; Pichard, Augusto D.; Kent, Kenneth M.; Stone, Gregg W.; Leon, Martin B.

doi:10.1161/01.cir.100.18.1872

Cited by 1,112 publications

(287 citation statements)

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“…A number of clinical studies have documented the challenge of treating ISR because of the high recurrence of restenosis (30% to 80%), 1,8 which is directly related to the length of the ISR lesion and independent of device selection. Only recently has catheter-based intravascular brachytherapy become available as an effective treatment for patients with ISR.…”

Section: Discussionmentioning

confidence: 99%

“…1 Regardless of which percutaneous approach is chosen to treat an in-stent restenotic lesion (balloon angioplasty, stent, rotational atherectomy, or laser angioplasty), 30% to 80% of the patients will develop restenosis within the stent, at the stent edges, or both. Currently, the only proven effective therapy available for patients with ISR is intravascular brachytherapy.…”

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confidence: 99%

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Sirolimus-Eluting Stent for the Treatment of In-Stent Restenosis

Sousa¹,

Costa²,

Abizaid³

et al. 2003

Circulation

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188

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Background-We have previously reported the safety and effectiveness of sirolimus-eluting stents for the treatment of de novo coronary lesions. The present investigation explored the potential of this technology to treat in-stent restenosis. Methods and Results-Twenty-five patients with in-stent restenosis were successfully treated with the implantation of 1 or 2 sirolimus-eluting Bx VELOCITY stents in São Paulo, Brazil. Nine patients received 2 stents (1.4 stents per lesion). Angiographic and volumetric intravascular ultrasound (IVUS) images were obtained after the procedure and at 4 and 12 months. All vessels were patent at the time of 12-month angiography. Angiographic late loss averaged 0.07Ϯ0.2 mm in-stent and Ϫ0.05Ϯ0.3 mm in-lesion at 4 months, and 0.36Ϯ0.46 mm in-stent and 0.16Ϯ0.42 mm in-lesion after 12 months. No patient had in-stent or stent margin restenosis at 4 months, and only one patient developed in-stent restenosis at 1-year follow-up. Intimal hyperplasia by 3-dimensional IVUS was 0.92Ϯ1.9 mm 3 at 4 months and 2.55Ϯ4.9 mm

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Section: Discussionmentioning

confidence: 99%

mentioning

confidence: 99%

Sirolimus-Eluting Stent for the Treatment of In-Stent Restenosis

Sousa¹,

Costa²,

Abizaid³

et al. 2003

Circulation

Self Cite

188

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“…ISR was defined as ≥50% diameter stenosis of the treated lesion. Based on Mehran's classification, 9 the angiographic pattern of ISR was classified as focal, diffuse or proliferative. Focal ISR was defined as <10 mm in length; containing multifocal ISR; and positioned at the body of the stent, the 5-mm proximal or distal margin of the stent, or in the stent overlap segment.…”

Section: Angiographic Analysismentioning

confidence: 99%

Qualitative and Quantitative Assessment of Stent Restenosis by Optical Coherence Tomography

Nagoshi

Shinke

Otake

et al. 2013

Circ J

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“…In-stent restenosis (ISR) was divided into focal (lesion length at chronic phase ≤ 10 m, type 1) and diffuse (> 10 mm, type 2, 3, and 4) types. 13) The percentages of type 2-4 ISR (ISR type 2-4 (%)) of the SES group were compared with those of the EES and BES groups, respectively.…”

Section: Methodsmentioning

confidence: 99%

Propensity-Score Matched Comparison of Midterm Angiographic Outcomes of Sirolimus- Versus Everolimus- and Biolimus-Eluting Stents for <i>De Novo</i> Coronary Stenosis

et al. 2017

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SummaryWe conducted propensity-score matched comparisons of midterm angiographic outcomes of sirolimus (SES) versus either everolimus-(EES) or biolimus-(BES) eluting stents after placements for coronary stenosis in a daily practice environment since previous randomized trials did not demonstrate the superiority of EES and BES over SES in terms of midterm angiographic outcomes.The present study was a non-randomized, retrospective, and lesion-based study, recruiting angiographically followed-up lesions within 550 days after successful and elective SES (n = 1793), EES (n = 1303), or BES (n = 324) placement for de novo native coronary stenosis during the period from August 2004 to January 2014 at 6 institutes. The endpoint, as an angiographic surrogate marker of clinical efficacy, was the distribution of in-stent follow-up percent diameter stenosis (%DS) which comprised the percentages of 1) follow-up %DS < 20 and 2) follow-up %DS > 50. Propensityscore matched analyses were conducted to adjust 21 baselines.In 1215 baseline adjusted lesions, the endpoints in the EES group [1) 74.1%, and 2) 4.6%] were significantly different from those in the SES group [57.9%; P < 0.001, 7.2%; P = 0.006, respectively). In 307 baseline adjusted lesions, the endpoints in the BES group [1) 80.5%, 2) 2.0%] were significantly different from those in the SES group [59.3%; P < 0.001, 2) 8.1%; P = 0.001, respectively].The present study is the first to confirm the superiority of midterm angiographic outcomes after the placement of EES and BES over SES for de novo coronary stenosis in a clinical setting. (Int Heart J 2017; 58: 320-327) Key words: Follow-up result, Angioplasty, Binary restenosis, Target lesion revascularization, Late luminal loss E verolimus-eluting stents (EES; Xience and Promus) have exhibited benefits associated with a favorable vascular response compared to sirolimus-eluting stents (SES; Cypher BxV and Select+), owing to their advanced drug-eluting stent (DES) technology that consists of the revised thin and flexible stent platform, anti-thrombogenic fluoropolymer, and drug. 1,2) The biolimus-eluting stent (BES; Nobori) also showed a better midterm intravascular response compared to SES, owing to its properties such as being a biodegradable polymer and the highest lipophilicity among the limus analogues. 3,4) However, despite these advanced aspects of EES and BES compared with the former evidence-based first generation "-limus" DES, that is, SES, prospective randomized trials have not demonstrated significantly better midterm angiographic outcomes for either EES 5,6) or BES 7,8) in terms of binary in-stent restenosis, TLR, or mean magnitude of in-stent late luminal loss compared to those of SES.In the present study, we conducted a retrospective comparison to examine the impact of the advances in coronary stent technology, represented by improved intravascular and pathological findings of either EES or BES over SES 1-4) on the overall midterm angiographic outcomes. For this purpose, 3420 lesions angiographically followed-up ...

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Angiographic Patterns of In-Stent Restenosis

Cited by 1,112 publications

References 34 publications

Sirolimus-Eluting Stent for the Treatment of In-Stent Restenosis

Sirolimus-Eluting Stent for the Treatment of In-Stent Restenosis

Qualitative and Quantitative Assessment of Stent Restenosis by Optical Coherence Tomography

Propensity-Score Matched Comparison of Midterm Angiographic Outcomes of Sirolimus- Versus Everolimus- and Biolimus-Eluting Stents for <i>De Novo</i> Coronary Stenosis

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