학술대회 안내 사전등록 안내 초록등록 안내 초록등록/관리 숙박및교통 안내


мȸ ǥ ʷ

ǥ : ȣ - 490444   109 
Is stent underexpansion the main cause of in-stent restenosis after sirolimus-eluting stent implantation? : A intravascular ultrasound study.
Cardiology Division, Cardiovascular center of National Health Insurance Corporation Ilsan Hospital, Koyang, Korea
Byoung-Keuk Kim, Seung Jin Oh, Dong Woon Jeon, Kyung Heui Kim, Kyung Jin Park, Yong Sun Moon, Joo Young Yang
Background: Intravascular ultrasound(IVUS) is useful in assessing causes of in-stent restenosis(ISR) after sirolimus-eluting stent(SES) implantation. We used IVUS to evaluate the causes of ISR after SES implantation. Methods: Between March 2003 and November 2004, a total of 332 patients(pts) with 437 lesions were treated with 520 SESs in our institute. 14 pts out of them had ISR in 15 lesions(3.4%), and IVUS assessment was applicable in 10 lesions of them. We described the patterns of ISR, and sought to find the possible causes of ISR after SES implantation with the aid of IVUS analysis. Results: 14 pts with ISR were: male 50%, diabetics 21%, and age 66 ± 9 years. Pre-procedural mean reference vessel diameter(RVD) was 2.80±0.32 mm, and lesion length(LL) was 36.9 ± 16.8 mm. In 6 lesions(40%), overlapping of 2 SESs was required for full lesion coverage. The pattern of ISR in 14 lesions(93%) was focal(gap; 1, margin; 2, body; 9, multifocal; 2 lesions). Diffuse ISR was noted in 1 lesion(restenotic LL; 14.5 mm). Analyzing IVUS-applicable 10 lesions, stent underexpansion [minimal stent CSA < 5 mm2 in non-small artery or minimal stent CSA < 4.5 mm2 in small vessel artery(RVD< 2.8 mm) was observed in 5 lesions(50%), and 2 lesions of them were chronic total occlusion. Stent fracture or stent discontinuity (absence of stent struts on IVUS at restenotic lesion) was identified in 3 lesions(30%)[one lesion of them was a gap between 2 different SESs, not overlapped on IVUS]. Proximal edge restenosis was shown in 2 lesions; one lesion was related to residual dissection after the procedure, the other to balloon trauma outside the stent. Except for edge ISR related to local injury, stent underexpansion(5 of 8 lesions, 63%) was the most common IVUS finding of intra-stent ISR. Conclusion: The common IVUS findings in SES restenosis in out study group are stent underexpansion, stent fracture, and edge restenosis related to local injury. In cases of intra-stent ISR(with the exception of edge restenosis), stent underexpansion was more related to coronary restenosis. Therefore, this study suggests that IVUS must be recommended to assess adequate expansion of stent and to prevent ISR.


[ư]