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ȣ - 530117 167 |
| Impact of Neoadventitia (Periadventitia Thickening) on Drug-eluting Stent Restenosis; An Intravascular Ultrasound Study |
| 중앙대학교병원 순환기내과 심장혈관센터¹ , Cardiovascular Research Foundation, NY² , 전남대학교병원³, 인제의대 일산백병원⁴, Washington Hospital Center, DC5 |
| 김상욱, Gary S. Mintz², 홍영준³ , 이성윤⁴, 이왕수, 조영미, 서재승, 홍준화, 이광제, 김태호, 김치정, 조대윤, Neil J. Weissman5, 류왕성 |
Background. Pathologic studies have suggested that formation of neoadventitia is part of the subsequent development of restenosis. Methods. We compared 45 pts who presented with drug-eluting stent (DES) failure to 20 pts with patent DES. IVUS measures were performed each 1 mm within the stent and stent edge. Vessel, stent, lumen, and intimal hyperplasia (IH) areas were measured. The area of Neoadventitia (AD) was measured outside the external elastic membrane at the maximal IH site. Results. Pt age was 59±8.95 yrs in DES failure vs 60±9.14 yrs in patent DES; 33% of DES failures vs 25% of patent DES were diabetic. Stent length was shorter in patent DES than DES failure (p=0.001). Minimal stent area was smaller in DES failure (p=0.012) and 30/45(66%) showed stent underexpansion (minimal stent area <5mm2). Maximal IH area was larger in DES failure (p<0.0001). Although DES failure showed larger AD area at the maximal IH area site (p=0.0002), maximal IH area was not correlated with AD area (r=0.122, p=0.423 in DES vs r=0.068, p=0.803 in patent DES). Conclusion. The formation of neoadventitia may be associated with higher lesion biologic activity and subsequent DES restenosis.
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DES failure |
patent DES |
p-value |
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Stent length |
30.34±12.57 |
21.37±6.66 |
0.001 |
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EEM area (mm2) |
12.79±3.96 |
13.59±5.12 |
0.528 |
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Minimum lumen area (mm2) |
2.51±0.78 |
3.08±1.43 |
0.00014 |
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Minimal stent area (mm2) |
4.70±1.50 |
5.74±1.63 |
0.012 |
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Maximal IH area(mm2) |
3.25±1.37 |
0.81±0.78 |
p<0.0001 |
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AD area(mm2) |
9.71±2.74 |
6.67±2.01 |
0.00015 |
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