Extent and distribution of in-stent intimal hyperplasia and edge effect in a non-radiation stent population

Weissman, Neil J.; Wilensky, Robert L.; Tanguay, Jean François; Bartorelli, Antonio L.; Moses, Jeffery W.; Williams, David O.; Bailey, Steven R.; Martin, Jack L.; Canos, Michael R.; Rudra, Harish; Popma, Jeffrey J.; Leon, Martin B.; Kaplan, Aaron V.; Mintz, Gary S.

doi:10.1016/s0002-9149(01)01635-6

Cited by 46 publications

(36 citation statements)

References 8 publications

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“…The lower remodeling index at the edge of the stent was not the result of intimal hyperplasia, but rather to constrictive remodeling, similar to postangioplasty restenosis. 14) The increase in the remodeling index observed after coronary stenting in this porcine model is consistent with a previous report that the antirestenosis effect due to probucol after balloon angioplasty is not due to the inhibition of intimal hyperplasia but rather to favorable remodeling. 15) Vascular injury by balloon angioplasty induces oxidative stress that impairs endothelial cell function.…”

Section: Discussionsupporting

confidence: 92%

Effect of Probucol on Neointimal Thickening in a Stent Porcine Restenosis Model

et al. 2004

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SUMMARYRestenosis after stent deployment remains a major clinical problem. Antioxidants have been proposed as a promising strategy against restenosis. We tested the antioxidant probucol for its efficacy against neointimal hyperplasia in porcine coronary arteries after stent implantation. Probucol was then tested in vivo in 8 coronary arteries of 4 pigs (1000 mg/day orally beginning 7 days before stenting) and was compared to placebo (10 coronary arteries, 5 pigs) 28 days after stenting. Quantitative intravascular ultrasound (IVUS) revealed 38.8 ± 4.0 versus 40.1 ± 3.0% area stenosis in the probucol versus control group. Histopathologic assessment showed that probucol had no beneficial effect on inhibiting the neointimal proliferative response in stent lesions compared to placebo (2.35 ± 0.26 versus 2.88 ± 0.25 mm 2 ), despite similar injury scores (1.20 ± 0.12 versus 1.28 ± 0.14). An edge segment (axially 2-mm proximal to the stent margins) was assessed by IVUS. Remodeling index, which is a good marker of constrictive remodeling, was defined by the ratio of the vessel area in the lesion site (stent edge) to the vessel area in the proximal reference site (6-mm proximal to the stent margins). The remodeling index was significantly larger in the probucol group that in the placebo group (1.18 ± 0.10 versus 0.90 ± 0.06, P = 0.0012). In conclusion, probucol reduced constrictive remodeling at the edge of the implant but did not inhibit the tissue response within the stent. (Jpn Heart J 2004; 45: 305-313)

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Section: Discussionsupporting

confidence: 92%

Effect of Probucol on Neointimal Thickening in a Stent Porcine Restenosis Model

et al. 2004

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“…In the present study, BMS demonstrated significant lumen loss in the distal reference segment without negative remodeling. In detailed subsegment analyses, we demonstrated that lumen loss in the 2 mm distal to the stent edge was related to plaque increase, in accordance with the results of Weisman et al 20 In contrast to BMS, TAXUS stents were associated with a beneficial effect on the distal reference segment, where no significant lumen narrowing was observed at follow-up. The subsegment analysis showed that this reflects the fact that positive vascular remodeling compensated for the increase in plaque burden in the reference segment immediately (Ͻ2 mm) adjacent to the stent.…”

Section: Remodeling In Segments Adjacent To the Stent: Insights From supporting

confidence: 91%

“…Previous studies regarding distal edge behavior in BMS have produced conflicting results. Mudra et al 1 reported no significant lumen loss or negative remodeling in the 3 mm distal to BMS edges, whereas Weissman et al 20 reported discordant results showing significant lumen loss throughout the distal reference segment. In the present study, BMS demonstrated significant lumen loss in the distal reference segment without negative remodeling.…”

Section: Remodeling In Segments Adjacent To the Stent: Insights From mentioning

confidence: 98%

“…However, there is controversy as to the mechanism(s) involved. Hoffmann et al 2 and Weissman et al 20 reported that this luminal loss was predominantly related to negative remodeling, whereas Mudra et al 1 suggested that it was related to an increase in plaque burden. In the present study, both BMS and TAXUS stents showed a significant decrease in lumen area in the proximal reference segment at follow-up.…”

Section: Remodeling In Segments Adjacent To the Stent: Insights From mentioning

confidence: 99%

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Vascular Responses at Proximal and Distal Edges of Paclitaxel-Eluting Stents

et al. 2004

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MD; for the TAXUS II Study GroupBackground-On the basis of brachytherapy experience, edge stenosis has been raised as a potential limitation for drug-eluting stents. We used serial intravascular ultrasound (IVUS) to prospectively analyze vessel responses in adjacent reference segments after implantation of polymer-controlled paclitaxel-eluting stents. Methods and Results-TAXUS II was a randomized, double-blind trial with 2 consecutive patient cohorts that compared slow-release (SR) and moderate-release (MR) paclitaxel-eluting stents with control bare metal stents (BMS). By protocol, all patients had postprocedure and 6-month follow-up IVUS. Quantitative IVUS analysis was performed by an independent core laboratory, blinded to treatment allocation, in 5-mm vessel segments immediately proximal and distal to the stent. Serial IVUS was available for 106 SR, 107 MR, and 214 BMS patients. For all 3 groups, a significant decrease in proximal-edge lumen area was observed at 6 months. The decrease was comparable (by ANOVA, Pϭ0.194) for patients in the SR (Ϫ0.54Ϯ2.1 mm 2 ) and MR (Ϫ0.88Ϯ1.9 mm 2 ) groups compared with the BMS (Ϫ1.02Ϯ1.9 mm 2 ) group. For the distal edge, a significant decrease in lumen area was only observed with BMS (Ϫ0.91Ϯ2.0 mm 2 , PϽ0.0001); this decrease was significantly attenuated with SR (0.08Ϯ2.0 mm 2 ) and MR (Ϫ0.19Ϯ1.7 mm 2 ) stents (PϽ0.0001 by ANOVA). Negative vessel remodeling was observed at the proximal (Ϫ0.48Ϯ2.2 mm 2 , Pϭ0.011) but not the distal edges of BMS and at neither edge of SR or MR stents. Conclusions-The marked reduction in in-stent restenosis with SR or MR stents is not associated with increased edge stenosis at 6-month follow-up IVUS. In fact, compared with BMS, there is instead a significant reduction in late lumen loss at the distal edge with TAXUS stents.

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“…Hoffmann, et al 19) found that the plaque burden of the reference segment was an independent predictor of stent edge stenosis. Other studies reported that a combination of intimal proliferation and negative remodeling was responsible for lumen reduction after bare metal stenting, [20][21][22] whereas edge stenosis after Paclitaxel-eluting stents and brachytherapy was due primarily to intimal proliferation. [22][23][24] Nevertheless, similar correlation between vessel remodeling and change in stent edge lumen was reported in the study of Mudra, et al 25) Vessel remodeling has been established as an important factor that controls late lumen outcomes following coronary interventions 14,[26][27][28][29][30] as shown in the present study.…”

Section: Discussionmentioning

confidence: 99%

<b>Poststenting Axial Redistribution of Atherosclerotic Plaque Into the Reference Segments and Lumen Reduction at the Stent Edge</b>

et al. 2006

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SUMMARYLumen enlargement during coronary stenting results from vessel expansion and axial redistribution of atheromatous plaque along the stented segment and proximal and distal reference segments. Plaque burden predicts stenosis at the stent edge. The aim of this study was to investigate the fate of shifted plaque with special reference to whether or not plaque shift (PSh) correlates with late lumen reduction. This is a prospective study conducted on 54 consecutive patients who underwent bare metal stenting. In all stent edges (108 edges), PSh volume was measured as postintervention plaque-media volume (PMV) minus preintervention PMV. Changes in lumen volume (∆LV), vessel volume (∆VV), and PMV (∆PMV) were measured by serial intravascular ultrasound (IVUS) examination. After stenting, PSh was detected in 81.5% of proximal edges versus 72.2% of distal edges (P = 0.36). It correlated significantly with ∆VV (r = 0.34, P = 0.002), and inversely with ∆LV (r = 0.32, P = 0.003). However, at 6-month follow-up, it did not correlate with ∆LV (r = −0.03, P = 0.8), ∆VV (r = 0.1, P = 0.6), or ∆PMV (r = 0.1, P = 0.4). Furthermore, ∆LV correlated more strongly with ∆VV (r = 0.62, P < 0.00001) than with ∆PMV (r = − 0.39, P = 0.001). By multivariate analysis, PSh area was an independent predictor of the postintervention change in lumen area (partial eta squared 0.21, P = 0.01), but not the follow-up change. Two patients (3.7%) developed proximal edge stenosis with no evident PSh after stenting. Thus, axial redistribution of atheromatous plaque into the reference segments was frequently encountered after stenting. Although PSh correlated with the immediate reduction in stent edge lumen volume, it did not correlate with the late lumen reduction. (Int Heart J 2006; 47: 159-171)

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Extent and distribution of in-stent intimal hyperplasia and edge effect in a non-radiation stent population

Cited by 46 publications

References 8 publications

Effect of Probucol on Neointimal Thickening in a Stent Porcine Restenosis Model

Effect of Probucol on Neointimal Thickening in a Stent Porcine Restenosis Model

Vascular Responses at Proximal and Distal Edges of Paclitaxel-Eluting Stents

<b>Poststenting Axial Redistribution of Atherosclerotic Plaque Into the Reference Segments and Lumen Reduction at the Stent Edge</b>

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