Abstract 15412: Impact of Hinge Motion on In-Stent Restenosis after Sirolimus-Eluting Stent Implantation
Background: A tortuous lesion with hinge motion is reportedly a risk factor for in-stent restenosis (ISR) after bare metal stent (BMS) implantation. Sirolimus-eluting stents (SESs) have dramatically reduced the rate of ISR. However, ISR remains a problem, especially in SESs with a closed-cell, stainless steel design, which has low conformability and flexibility. Several studies have reported the relationship between hinge motion and stent fracture after SES implantation. However, the efficacy of SES in a tortuous lesion with hinge motion has not been fully evaluated. The aim of this study was to investigate the relationship between tortuous lesions and ISR after SES implantation.
Methods: We obtained 3-year clinical follow-up data after SES implantation including 6–9 months scheduled follow-up coronary angiography (CAG) in 399 consecutive patients with 537 lesions and divided them into two groups: with and without ISR. The Δangle was defined as the difference in the angle of the target lesion between diastole and systole before the procedure.
Results: The incidence of ISR was 8.2% (44 of 537 lesions). Mean maximal angle and Δangle were larger in the ISR group (47±22° vs 37±21°, p=0.004 and 20±13° vs 13±10°, p<0.0001, respectively). Independent predictors of ISR were Δangle (every 1-degree increment; OR=1.051, P=0.007), hemodialysis (OR=16.38, P<0.001), aortic ostium stenting (OR=7.389, P=0.012), and diabetes mellitus (OR=2.342, P=0.024). The optimal cut-off value of Δangle that best predicted ISR was 15.5°, with a sensitivity and specificity of 64% and 74%, respectively, based on receiver-operating characteristic (ROC) curve (area under the curve= 0.695, 95%CI 0.60–0.78, p<0.05). Hinge motion-associated ISR (Δangle≥16 °) occurred in 28 lesions: stent fracture in 9, stent recoil in 6, edge injury in 11, and unclassified lesion in 3.
Conclusions: The Δangle was one of the predictors of ISR after SES implantation. The amount of hinge motion in tortuous lesions should be considered in planning SES implantation.
- © 2010 by American Heart Association, Inc.