(Circulation. 1996;94:1247-1254.)
© 1996 American Heart Association, Inc.
Articles |
Patterns and Mechanisms of In-Stent Restenosis
A Serial Intravascular Ultrasound Study
the Intravascular Ultrasound Imaging and Cardiac Catheterization Laboratories, Washington Hospital Center, Washington, DC.
Correspondence to Martin B. Leon, MD, Director of Research, Washington Cardiology Center, 110 Irving St NW, Ste 4B1, Washington, DC 20010.
Background Studies have suggested that restenosis within Palmaz-Schatz stents results from neointimal hyperplasia or chronic stent recoil and occurs more frequently at the articulation.
Methods and Results Serial intravascular ultrasound (IVUS) was performed after intervention and at follow-up in 142 stents in 115 lesions. IVUS measurements (external elastic membrane [EEM], stent, and lumen cross-sectional areas [CSAs] and diameters) were performed, and plaque CSA (EEM lumen in reference segments and stent lumen in stented segments), late lumen loss (
lumen), remodeling (EEM in reference segments and stent in stented segments), and tissue growth (plaque) were calculated. After intervention, the lumen tended to be smallest at the articulation because of tissue prolapse. At follow-up, tissue growth was uniformly distributed throughout the stent; the tendency for greater neointimal tissue accumulation at the central articulation reached statistical significance only when normalized for the smaller postintervention lumen CSA. In stented segments, late lumen area loss correlated strongly with tissue growth but only weakly with remodeling. Stents affected adjacent vessel segments; remodeling progressively increased and tissue growth progressively decreased at distances from the edge of the stent. These findings were similar in native arteries and saphenous vein grafts and in lesions treated with one or two stents. There was no difference in the postintervention or follow-up lumen (at the junction of the two stents) when overlapped were compared with nonoverlapped stents.
Conclusions Late lumen loss and in-stent restenosis were the result of neointimal tissue proliferation, which tended to be uniformly distributed over the length of the stent.
Key Words: stents • ultrasonics • restenosis • angioplasty
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K. Egashira Molecular Mechanisms Mediating Inflammation in Vascular Disease: Special Reference to Monocyte Chemoattractant Protein-1 Hypertension, March 1, 2003; 41(3): 834 - 841. [Abstract] [Full Text] [PDF]
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I.-M. o Chung, H. K. Gold, S. M. Schwartz, Y. Ikari, M. A. Reidy, and T. N. Wight Enhanced extracellular matrix accumulation in restenosis of coronary arteries after stent deployment J. Am. Coll. Cardiol., December 18, 2002; 40(12): 2072 - 2081. [Abstract] [Full Text] [PDF]
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F. Versaci, A. Gaspardone, F. Tomai, F. Ribichini, P. Russo, I. Proietti, A. S. Ghini, V. Ferrero, L. Chiariello, P. Agostino Gioffre, et al. Immunosuppressive therapy for the prevention of restenosis after coronary artery stent implantation (IMPRESS study) J. Am. Coll. Cardiol., December 4, 2002; 40(11): 1935 - 1942. [Abstract] [Full Text] [PDF]
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J. F. LaDisa Jr., D. A. Hettrick, L. E. Olson, I. Guler, E. R. Gross, T. T. Kress, J. R. Kersten, D. C. Warltier, and P. S. Pagel Stent implantation alters coronary artery hemodynamics and wall shear stress during maximal vasodilation J Appl Physiol, December 1, 2002; 93(6): 1939 - 1946. [Abstract] [Full Text] [PDF]
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M. N. Babapulle and M. J. Eisenberg Coated Stents for the Prevention of Restenosis: Part I Circulation, November 19, 2002; 106(21): 2734 - 2740. [Full Text] [PDF]
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I. P. Casserly, H. D. Aronow, P. Schoenhagen, H. Tsutsui, J. Popovich, M. Goormastic, J. J. Popma, S. E. Nissen, and E. M. Tuzcu Relationship between residual atheroma burden and neointimal growth in patients undergoing stenting: Analysis of the atherectomy before MULTI-LINK improves lumen gain and clinical outcomes trial intravascular ultrasound substudy J. Am. Coll. Cardiol., November 6, 2002; 40(9): 1573 - 1578. [Abstract] [Full Text] [PDF]
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F. G.P. Welt and C. Rogers Inflammation and Restenosis in the Stent Era Arterioscler Thromb Vasc Biol, November 1, 2002; 22(11): 1769 - 1776. [Abstract] [Full Text] [PDF]
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V. M. Shah, G. S. Mintz, S. Apple, and N. J. Weissman Background Incidence of Late Malapposition After Bare-Metal Stent Implantation Circulation, October 1, 2002; 106(14): 1753 - 1755. [Abstract] [Full Text] [PDF]
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J. J. Popma, M. Suntharalingam, A. J. Lansky, R. R. Heuser, B. Speiser, P. S. Teirstein, V. Massullo, T. Bass, R. Henderson, S. Silber, et al. Randomized Trial of 90Sr/90Y {beta}-Radiation Versus Placebo Control for Treatment of In-Stent Restenosis Circulation, August 27, 2002; 106(9): 1090 - 1096. [Abstract] [Full Text] [PDF]
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G. Theilmeier, R. Quarck, P. Verhamme, M.-L. Bochaton-Piallat, M. Lox, H. Bernar, S. Janssens, M. Kockx, G. Gabbiani, D. Collen, et al. Hypercholesterolemia impairs vascular remodelling after porcine coronary angioplasty Cardiovasc Res, August 1, 2002; 55(2): 385 - 395. [Abstract] [Full Text] [PDF]
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Z. Chen, T. Fukutomi, A. C. Zago, R. Ehlers, P. A. Detmers, S. D. Wright, C. Rogers, and D. I. Simon Simvastatin Reduces Neointimal Thickening in Low-Density Lipoprotein Receptor-Deficient Mice After Experimental Angioplasty Without Changing Plasma Lipids Circulation, July 2, 2002; 106(1): 20 - 23. [Abstract] [Full Text] [PDF]
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M.-C. Morice, P. W. Serruys, J. E. Sousa, J. Fajadet, E. Ban Hayashi, M. Perin, A. Colombo, G. Schuler, P. Barragan, G. Guagliumi, et al. A Randomized Comparison of a Sirolimus-Eluting Stent with a Standard Stent for Coronary Revascularization N. Engl. J. Med., June 6, 2002; 346(23): 1773 - 1780. [Abstract] [Full Text] [PDF]
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Y. Yoshitomi, S. Kojima, M. Yano, Y. Matsumoto, T. Sugi, M. Saotome, K.-e Tanaka, M. Endo, and M. Kuramochi Peristent Tissue Proliferation of Multilink Stents Is Dependent on Preprocedural Plaque Area: A Serial Intravascular Ultrasound Analysis Angiology, May 1, 2002; 53(3): 303 - 311. [Abstract] [PDF]
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A. E. Ajani, R. Waksman, D.-H. Cha, L. Gruberg, L. F. Satler, A. D. Pichard, and K. M. Kent The impact of lesion length and reference vessel diameter on angiographic restenosis and target vessel revascularization in treating in-stent restenosis with radiation J. Am. Coll. Cardiol., April 17, 2002; 39(8): 1290 - 1296. [Abstract] [Full Text] [PDF]
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A. B. Buchwald, A. H. Wagner, C. Webel, and M. Hecker Decoy oligodeoxynucleotide againstactivator protein-1 reducesneointimal proliferation after coronaryangioplasty in hypercholesterolemic minipigs J. Am. Coll. Cardiol., February 20, 2002; 39(4): 732 - 738. [Abstract] [Full Text] [PDF]
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H. C. Lowe, S. N. Oesterle, and L. M. Khachigian Coronary in-stent restenosis: Current status and future strategies J. Am. Coll. Cardiol., January 16, 2002; 39(2): 183 - 193. [Abstract] [Full Text] [PDF]
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J. A. Ormiston, M. W.I. Webster, P. N. Ruygrok, A. Kastrati, J. Mehilli, H. Schuhlen, A. Schomig, J. Dirschinger, F.-J. Neumann, M. Seyfarth, et al. Stent Strut Thickness and Restenosis Response Circulation, January 15, 2002; 105 (2): e12 - e12. [Full Text] [PDF]
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E. C. Kirsch, M. S. Khangure, P. Morling, T. J. York, and W. McAuliffe Oversizing of Self-Expanding Stents: Influence on the Development of Neointimal Hyperplasia of the Carotid Artery in a Canine Model AJNR Am. J. Neuroradiol., January 1, 2002; 23(1): 121 - 127. [Abstract] [Full Text] [PDF]
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M. Ii, M. Hoshiga, R. Fukui, N. Negoro, T. Nakakoji, F. Nishiguchi, E. Kohbayashi, T. Ishihara, and T. Hanafusa Beraprost sodium regulates cell cycle in vascular smooth muscle cells through cAMP signaling by preventing down-regulation of p27Kip1 Cardiovasc Res, December 1, 2001; 52(3): 500 - 508. [Abstract] [Full Text] [PDF]
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B.J Rensing, J Vos, P.C Smits, D.P Foley, M.J.B.M van den Brand, W.J van der Giessen, P.J de Feijter, and P.W Serruys Coronary restenosis elimination with a sirolimus eluting stent; First European human experience with 6-month angiographic and intravascular ultrasonic follow-up Eur. Heart J., November 2, 2001; 22(22): 2125 - 2130. [Abstract] [PDF]
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S. Windecker and B. Meier All stents are not alike or is the difference in the eye of the observer only? Eur. Heart J., November 1, 2001; 22(21): 1973 - 1977. [PDF]
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R. Hoffmann, C. Jansen, A. Konig, P.K. Haager, G. Kerckhoff, J. Vom Dahl, V. Klauss, P. Hanrath, and H. Mudra Stent design related neointimal tissue proliferation in human coronary arteries; an intravascular ultrasound study Eur. Heart J., November 1, 2001; 22(21): 2007 - 2014. [Abstract] [PDF]
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R. Hoffmann, P. Haager, G.S. Mintz, G. Kerckhoff, R. Schwarz, A. Franke, J. Vom Dahl, and P. Hanrath The impact of high pressure vs low pressure stent implantation on intimal hyperplasia and follow-up lumen dimensions; results of a randomized trial Eur. Heart J., November 1, 2001; 22(21): 2015 - 2024. [Abstract] [PDF]
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E. Jorgensen, H. Kelbaek, S. Helqvist, G. V. H. Jensen, K. Saunamaki, J. Kastrup, O. Havndrup, H. Bundgaard, J. Kyst Madsen, M. Christiansen, et al. Predictors of coronary in-stent restenosis: importance of angiotensin-converting enzyme gene polymorphism and treatment with angiotensin-converting enzyme inhibitors J. Am. Coll. Cardiol., November 1, 2001; 38(5): 1434 - 1439. [Abstract] [Full Text] [PDF]
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P. Vermeersch, Z. Nong, E. Stabile, O. Varenne, H. Gillijns, M. Pellens, N. Van Pelt, M. Hoylaerts, I. De Scheerder, D. Collen, et al. L-Arginine Administration Reduces Neointima Formation After Stent Injury in Rats by a Nitric Oxide-Mediated Mechanism Arterioscler Thromb Vasc Biol, October 1, 2001; 21(10): 1604 - 1609. [Abstract] [Full Text] [PDF]
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G. S. Mintz, N. J. Weissman, and P. J. Fitzgerald Intravascular Ultrasound Assessment of the Mechanisms and Results of Brachytherapy Circulation, September 11, 2001; 104(11): 1320 - 1325. [Full Text] [PDF]
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F.-J. Neumann, A. Kastrati, T. Miethke, J. Mehilli, G. Pogatsa-Murray, W. Koch, M. Seyfarth, and A. Schomig Previous Cytomegalovirus Infection and Restenosis After Coronary Stent Placement Circulation, September 4, 2001; 104(10): 1135 - 1139. [Abstract] [Full Text] [PDF]
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N. Mercado, E. Boersma, W. Wijns, B. J. Gersh, C. A. Morillo, V. de Valk, G.-A. van Es, D. E. Grobbee, and P. W. Serruys Clinical and quantitative coronary angiographic predictors of coronary restenosis: A comparative analysis from the balloon-to-stent era J. Am. Coll. Cardiol., September 1, 2001; 38(3): 645 - 652. [Abstract] [Full Text] [PDF]
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M. Adamian, A. Colombo, C. Briguori, T. Nishida, F. Marsico, C. Di Mario, R. Albiero, I. Moussa, and J. W. Moses Cutting balloon angioplasty for the treatment of in-stent restenosis: a matched comparison with rotational atherectomy, additional stent implantation and balloon angioplasty J. Am. Coll. Cardiol., September 1, 2001; 38(3): 672 - 679. [Abstract] [Full Text] [PDF]
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