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| Intravascular Ultrasound Findings of Edge Restenosis Following Long Sirolimus-Eluting Stent Implantation |
| 1전남대학교병원 심장센터, 2Cardiovascular Research Foundation, New York, New York, 3중앙대학교병원심장센터, 4인제대학교일산백병원, 5서울의료원, 6Cardiovascular Research Institute/Medstar Research Institute, Washington Hospital Center, Washington, DC |
| 홍영준1, 정명호1, Gary S. Mintz2, 김상욱3, 이성윤4, 김석연5, 안영근1, Augusto D. Pichard6, Lowell F. Satler6, Ron Waksman6, Kenneth M. Kent6, William O. Suddath6, 조정관1, 박종춘1, Neil J. Weissman6, 강정채1 |
We investigated the intravascular ultrasound (IVUS) findings of stent edge restenosis (angiographic diameter stenosis ≥50% within 5mm of the proximal or distal stent edge) after long (28 and 33mm) sirolimus-eluting stent (SES) implantation. We compared post-stenting and follow-up IVUS findings between a group with edge restenosis (n=11) and a group without restenosis (n=15). Results: Stent length was not different between the two groups (31.2±2.6 vs. 31.0±2.5 mm). Post-stenting, edge lumen cross-sectional area (CSA) was smaller and edge plaque&media (P&M) CSA and plaque burden (P&M divided by external elastic membrane [EEM]) were larger in the edge restenosis group; however, minimum stent area was not different between the two groups. At follow-up, there was more intimal hyperplasia; a greater increase in edge P&M and EEM CSA and plaque burden; and a greater decrease in lumen CSA in the edge restenosis group (Table).
Conclusions: Edge restenosis in pts undergoing long SES implantation occurs in the setting of large residual stent edge plaque burden and is caused by a greater increase in intimal hyperplasia and edge plaque growth. This supports the trend to full lesion coverage (ideally using IVUS guidance) when implanting long SES.
|
Variables |
Edge restenosis
(n=11) |
No edge restenosis
(n=15) |
p value |
|
Post-stenting edge EEM CSA (mm2) |
11.4±3.3 |
10.7±3.9 |
0.609 |
|
Post-stenting edge lumen CSA (mm2) |
5.0±1.3 |
7.3±2.3 |
0.004 |
|
Post-stenting edge P&M CSA (mm2) |
6.4±2.8 |
3.4±2.2 |
0.004 |
|
Post-stenting edge plaque burden (%) |
55.6±10.5 |
29.0±14.3 |
<0.001 |
|
Minimum stent CSA (mm2) |
6.6±1.7 |
7.4±1.9 |
0.236 |
|
% Edge neointimal hyperplasia |
27.5±29.2 |
2.8±7.4 |
0.019 |
|
D Edge EEM CSA (mm2) |
1.0±0.8 |
0.1±0.3 |
0.004 |
|
D Edge lumen CSA (mm2) |
-0.9±0.8 |
-0.1±0.5 |
0.003 |
|
D Edge P&M CSA (mm2) |
1.9±1.1 |
0.2±0.4 |
<0.001 |
|
D Edge plaque burden (%) |
11.2±7.3 |
2.1±4.4 |
0.001 |
|
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