Circulation. 2003;108:257-260
Published online before print July 14, 2003, doi: 10.1161/01.CIR.0000083366.33686.11
Published online before print July 14, 2003, doi: 10.1161/01.CIR.0000083366.33686.11
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(Circulation. 2003;108:257.)
© 2003 American Heart Association, Inc.
Brief Rapid Communications |
Coronary Restenosis After Sirolimus-Eluting Stent Implantation
Morphological Description and Mechanistic Analysis From a Consecutive Series of Cases
From Erasmus Medical Center, Thoraxcenter, Rotterdam, the Netherlands.
Correspondence to Prof P.W. Serruys, MD, PhD, Thoraxcenter, Bd-406, Dr Molewaterplein 40, 3015-GD Rotterdam, The Netherlands. E-mail p.w.j.c.serruys{at}erasmusmc.nl
Received March 25, 2003; de novo received May 2, 2003; revision received June 3, 2003; accepted June 5, 2003.
Background— We describe the clinical and morphological patterns of restenosis after sirolimus-eluting stent (SES) implantation.
Methods and Results— From 121 patients with coronary angiography obtained >30 days after SES implantation, restenosis (diameter stenosis >50%) was identified in 19 patients and 20 lesions (located at the proximal 5-mm segment in 30% or within the stent in 70%). Residual dissection after the procedure or balloon trauma outside the stent was identified in 83% of the proximal edge lesions. Lesions within the stent were focal, and stent discontinuity was identified in some lesions evaluated by intravascular ultrasound.
Conclusions— Sirolimus-eluting stent edge restenosis is frequently associated with local trauma outside the stent. In-stent restenosis occurs as a localized lesion, commonly associated with a discontinuity in stent coverage. Local conditions instead of intrinsic drug-resistance to sirolimus are likely to play a major role in post-SES restenosis.
Key Words: restenosis • stents • angioplasty
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