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ȣ - 530862 164 |
Ischemic-driven late target lesion revascularization due to “Catch-up” phenomenon after implantation of drug eluting stents |
가톨릭의대 |
박훈준, 승기배, 김범준, 박찬석, 최익준,박만원, 백주열, 윤성규, 박재홍, 정해옥, 백상홍 |
Backgrounds
Concerns have been raised about the “late Catch-up” (LCU) phenomenon in the drug-eluting stents (DES) era.
Objectives
This study sought to assess the incidence rate, and clinical and angiographic characteristics of LCU phenomenon in patients with late ischemic-driven TLR after DES implantation.
Methods and results
Of 674 patients undergoing DES stenting, 334 (49.5%) patients had 6- to 8-month angiographic follow-up and were enrolled in the study. Target lesion revascularization was performed in 8 patients; these patients were not considered for further analysis. Of 326 remaining patients, 87 (26.7%) patients received ischemic-driven follow-up CAG (median duration: 22.7 months, range: 12.8 to 60.5 months). 25 (7.7%) patients underwent non-target lesion revascularization due to the progression of de novo lesion and 21 (6.4%) patients underwent ischemic driven TLR due to LCU phenomenon, which was defined as 1) newly developed ischemic symptoms and/or evidences of myocardial ischemia on stress tests after the routine follow-up CAG and 2) significant restenosis (percent diameter stenosis≥70%) in the target lesion on ischemic-driven follow-up CAG. In LCU group, sixteen (76.2%) were sirolimus-eluting stent and four (23.8%) were paclitaxel-eluting stent. In patterns of neointimal growth, 14/21 (66.7%) were focal and 11/14 (78.6%) were in-segment restenosis. Their baseline serum creatinine (1.87mg/dl vs. 0.94 mg/dl, p=0.053) and CRP level (0.75ng/ml vs. 0.15mg/ml, p=0.045) were higher than those of no interval change at ischemic-driven follow-up CAG.
Conclusion
LCU phenomenon might be associated with systemic chronic inflammations and showed different patterns according to the stent platforms.
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