(Circulation. 2001;103:14.)
© 2001 American Heart Association, Inc.
Brief Rapid Communications |
Radioactive Stents Delay but Do Not Prevent In-Stent Neointimal Hyperplasia
From the Thoraxcenter, University Hospital Rotterdam, Dijkzigt, and the Daniel den Hoed Cancer Center (P.C.L.), Rotterdam, the Netherlands.
Correspondence to Prof Patrick W. Serruys, MD, PhD, Department of Interventional Cardiology, Thoraxcenter Bd 406, University Hospital Dijkzigt, Dr Molewaterplein 40, 3015 GD Rotterdam, The Netherlands. E-mail Serruys{at}card.azr.nl
Background—Restenosis after conventional stenting is almost exclusively caused by neointimal hyperplasia. ß-Particle–emitting radioactive stents decrease in-stent neointimal hyperplasia at 6-month follow-up. The purpose of this study was to evaluate the 1-year outcome of 32P radioactive stents with an initial activity of 6 to 12 µCi using serial quantitative coronary angiography and volumetric ECG-gated 3D intravascular ultrasound (IVUS).
Methods and Results—Of 40 patients undergoing initial stent implantation, 26 were event-free after the 6-month follow-up period and 22 underwent repeat catheterization and IVUS at 1 year; they comprised half of the study population. Significant luminal deterioration was observed within the stents between 6 months and 1 year, as evidenced by a decrease in the angiographic minimum lumen diameter (-0.43±0.56 mm; P=0.028) and in the mean lumen diameter in the stent (-0.55±0.63 mm; P=0.001); a significant increase in in-stent neointimal hyperplasia by IVUS (18.16±12.59 mm3 at 6 months to 27.75±11.99 mm3 at 1 year; P=0.001) was also observed. Target vessel revascularization was performed in 5 patients (23%). No patient experienced late occlusion, myocardial infarction, or death. By 1 year, 21 of the initial 40 patients (65%) remained event-free.
Conclusions—Neointimal proliferation is delayed rather than prevented by radioactive stent implantation. Clinical outcome 1 year after the implantation of stents with an initial activity of 6 to 12 µCi is not favorable when compared with conventional stenting.
Key Words: radioisotopes • restenosis • stents • angiography
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