Angiographic Patterns of Restenosis With 2nd Generation Drug-Eluting Stent

Abstract

SummaryThe angiographic features of restenosis contain prognostic information. However, restenosis patterns of the new generation drug-eluting stents (DES), everolimus-(EES) and resolute zotarolimus-eluting stent (ZES) have not been described.A total of 210 consecutive patients with DES restenosis were enrolled from 2003 to 2012. We analyzed 217 restenotic lesions after DES implantation, and compared the morphologic characteristics of the 2nd generation DES restenosis to those of restenosis with 2 first generation DES, sirolimus-(SES) and paclitaxel-eluting stent (PES).Baseline characteristics were comparable between the different stent groups. The incidence of focal restenosis was significantly lower for PES than the other stents (49.5% versus 87.0%, 76.2%, and 82.1% for PES versus SES, EES, and ZES, respectively, P < 0.001). When considering the pattern of restenosis solely within the stent margins, a further clear distinction between PES and other stents was observed (40.0% versus 92.9%, 88.9%, and 81.2% in PES versus SES, EES, and ZES, respectively, P < 0.001). There were no significant differences in restenosis patterns among SES, EES, and ZES. In multivariate analysis, PES implantation, hypertension, and age were associated with non-focal type of restenosis after DES implantation. After the introduction of EES and ZES into routine clinical practice in 2008, focal restenosis significantly increased from 63.9% to 76.7% and diffuse restenosis significantly decreased from 26.4% to 11.0% (P = 0.045).Focal restenosis was the most common pattern of restenosis in the new generation DES and the incidence of diffuse restenosis significantly decreased with the introduction of the 2nd generation DES. (Int Heart J 2015; 56: 6-12) Key words: Coronary, Intervention, Angioplasty, Angiography I n the stent era, in-stent restenosis (ISR) has been one of the major issues of percutaneous coronary intervention (PCI). 1) Even if drug-eluting stents (DES) dramatically reduce the rates of restenosis and target lesion revascularization (TLR) after PCI, 2) DES restenosis is still clinically important with the expansion of the indications for PCI to high-risk patients and complex lesions. The angiographic presentation of ISR may have important prognostic information on subsequent TLR not only after bare-metal stent (BMS) implantation 3) but also after DES implantation. 4,5) Moreover, the morphologic classification of DES ISR remains an important predictor of clinical outcomes after ISR treatment. [4][5][6] The newer DES, such as everolimus-eluting stents (EES) and Resolute zotarolimus-eluting stents (ZES), are characterized by improvements in stent platform, polymer, and drug, with the aim of minimizing the incidence of DES ISR and improving safety.7-10) However, the angiographic patterns of the new generation DES ISR have not been fully described yet. Thus, we analyzed the angiographic patterns of restenosis that occurred after DES implantation in our institution, and compared the morphologic patterns of the new generation DES ISR ...

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

“…Thus, although the incidences of stent fracture of these DESs at follow-up CAG could not be demonstrated, the lower incidence of stent fracture of 2nd-generation DES (EES and BES) could be attributed to the present overall better angiographic outcomes of EES and BES over SES. Fifth, the similar percentages of type 2-4 ISR (ISR type 2-4 (%)) between EES and SES was consistent with Lee, et al 27) However, we could not obtain clear estimates of the percentages of type 2-4 ISR (ISR type 2-4 (%)) in the EES and BES groups compared with those in the SES group (Tables II and IV), despite the overall better angiographic outcomes of EES and BES over SES. Sixth, we could not clearly show the percentage of stent thrombosis in each DES group.…”

Restenosis patterns after bioresorbable vascular scaffold implantation: Angiographic substudy of the GHOST‐EU registry

“…In this study, we report for the first time the patterns of angiographic in-stent restenosis [5,[9][10][11]31]. Our finding that the majority of IBR is of focal morphology is reassuring.…”

Impact of hyperuricemia on clinical outcomes after percutaneous coronary intervention for in-stent restenosis

“…Previously, elevated serum hsCRP level was reported as a risk predictor of non-focal-type ISR after DES implantation, suggesting that inflammatory activity might contribute to aggressive restenosis [ 31 ]. In addition, old age, hypertension, diabetes mellitus, and paclitaxel-eluting stent implantation were also reported to be associated with the non-focal type of ISR [ 32 – 34 ]. Thus, considering that hyperuricemia is associated with elevated hsCRP level and other inflammatory markers, it could also be another possible biomarker for non-focal-type ISR.…”