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Prediction of late restenosis after sirolimus-eluting stent implantation using serial quantitative angiographic and intravascular ultrasound analysis

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Abstract

Although sirolimus-eluting stents (SESs) have shown to significantly reduce the incidence of restenosis, it remains unclear when the follow-up angiography should be performed after SES implantation. A total of 868 patients with 1,574 lesions were treated with SES. Of the 71 patients with 87 lesions were performed serial angiographic and intravascular ultrasound (IVUS) analysis (pre, post, 1st and 2nd-follow-up). The first follow-up period was 7.9 ± 3.5 months and the second follow-up was 18.9 ± 7.7 months. Late restenosis (LR) was defined as diameter stenosis ≥50% at second follow-up, which was <50% at first follow-up. A total of restenosis was documented in 69 patients with 89 lesions (5.7%) overall, 13 lesions (3.2%) led to LR. Angiographic pattern of LR was predominately focal pattern. In LR group, late lumen loss by angiography was increased between 1st-follow-up and 2nd-follow-up (0.69 ± 0.41 mm in first follow-up and 1.98 ± 0.44 mm in second follow-up, p < 0.0001). Minimum lumen area (MLA) by IVUS had slightly decreased already in 1st-follow-up (6.07 ± 2.31 mm2 in post procedure and 4.71 ± 2.05 mm2 in 1st-follow-up, p = 0.098) and significantly decreased in 2nd-follow-up (6.07 ± 2.31 mm2 in post procedure and 1.71 ± 0.93 mm2 in 2nd-follow-up, p < 0.0001). However, in each period, there were no significant difference in both late lumen loss and MLA in non-LR group. Neointima growth prolonged gradually over 1 year in LR group. These findings suggest that if neointimal proliferation is recognized in short-term-follow-up period, long-follow-up should be needed.

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Abbreviations

LR:

Late restenosis

MLA:

Minimum lumen area

TLR:

Target lesion revascularization

LST:

Late stent thrombosis

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Acknowledgments

We thank all members of the cardiovascular institute and the catheter laboratory; Mr. Eiji Noguchi, Ms. Erika Miura, and Ms. Yoshie Takanashi, for their valuable suggestions and advice in the measurement of data.

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Authors and Affiliations

  1. Department of Cardiology, The Cardiovascular Institute Hospital, 7-3-10 Roppongi Minato-ku, Tokyo, 106-0032, Japan

    Ryuichi Funada, Yuji Oikawa, Junji Yajima, Shunsuke Matsuno, Hiroto Kano, Hajime Kirigaya, Kazuyuki Nagashima & Tadanori Aizawa

  2. Department of Medicine and Biological Science, Gunma University Graduate School of Medicine, Gunma, Japan

    Masahiko Kurabayashi

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  1. Ryuichi Funada
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  2. Yuji Oikawa
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Correspondence to Ryuichi Funada.

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Funada, R., Oikawa, Y., Yajima, J. et al. Prediction of late restenosis after sirolimus-eluting stent implantation using serial quantitative angiographic and intravascular ultrasound analysis. Cardiovasc Interv and Ther 26, 26–32 (2011). https://doi.org/10.1007/s12928-010-0030-3

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  • DOI: https://doi.org/10.1007/s12928-010-0030-3

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