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(Circulation. 2004;109:1085-1088.)
© 2004 American Heart Association, Inc.

Brief Rapid Communications

Contribution of Stent Underexpansion to Recurrence After Sirolimus-Eluting Stent Implantation for In-Stent Restenosis

Kenichi Fujii, MD; Gary S. Mintz, MD; Yoshio Kobayashi, MD; Stéphane G. Carlier, MD, PhD; Hideo Takebayashi, MD; Takenori Yasuda, MD; Issam Moussa, MD; George Dangas, MD, PhD; Roxana Mehran, MD; Alexandra J. Lansky, MD; Arlene Reyes, MD; Edward Kreps, MD; Michael Collins, MD; Antonio Colombo, MD; Gregg W. Stone, MD; Paul S. Teirstein, MD; Martin B. Leon, MD; Jeffrey W. Moses, MD

From the Cardiovascular Research Foundation, Lenox Hill Heart and Vascular Institute, New York, NY.

Reprint requests to Jeffrey W. Moses, MD, Lenox Hill Heart and Vascular Institute, 130 E 77th St, 9th Floor, New York, NY 10021. E-mail jmoses{at}lenoxhill.net

Received December 1, 2003; revision received January 16, 2004; accepted January 22, 2004.

Background— We used intravascular ultrasound (IVUS) to evaluate recurrence after sirolimus-eluting stent (SES) implantation treatment of in-stent restenosis (ISR).

Methods and Results— Forty-eight ISR lesions (41 patients with objective evidence of ischemia) were treated with SES. Recurrent ISR was identified in 11 lesions (all focal); repeat revascularization was performed in 10. These were compared with 16 patients (19 lesions) without recurrence as documented by angiography. Nine of 11 recurrent lesions had a minimum stent area (MSA) <5.0 mm² versus 5 of 19 nonrecurrent lesions (P=0.003); 7 of 11 recurrent lesions had an MSA <4.0 mm² versus 4 of 19 nonrecurrent lesions (P=0.02); and 4 of 11 recurrent lesions had an MSA <3.0 mm² versus 1 of 19 nonrecurrent lesions (P=0.03). A gap between SESs was identified in 3 of 11 recurrences versus 1 of 19 nonrecurrent lesions.

Conclusions— Stent underexpansion is a significant cause of failure after SES implantation treatment of ISR.

Key Words: ultrasonics • restenosis • stents

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