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The frequency and clinical characteristics of in-stent restenosis due to calcified nodule development after coronary stent implantation

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Abstract

The purpose of this study was to evaluated the clinical characteristics of calcified nodule-like in-stent restenosis (ISR) lesions using optical coherence tomography (OCT) in vivo. A total of 124 ISR lesions that were treated with a repeat coronary intervention under OCT guidance were included in this analysis. ISR neointimal morphology was classified as “calcified nodule-like ISR”, that appeared as a high-backscattering protruding mass with an irregular surface covered by signal-rich bands, or “non-calcified nodule-like ISR”. The maximum arc and thickness of calcium behind the stent struts was also measured. Of the 124 ISR lesions, calcified nodule-like ISR was observed in 11 lesions (9%). OCT analysis data showed that the maximum arc of calcium and the maximum calcium thickness behind the stent were significantly larger in the calcified nodule-like ISR lesions than in the non-calcified nodule-like ISR lesions (269 ± 51 vs. 179 ± 92°, p < 0.01 and 989 ± 174 vs. 684 ± 241 μm, p < 0.01, respectively). The enlargement of the stent area was significantly larger in the calcified nodule-like ISR lesions than in the non-calcified nodule-like ISR lesions (1.6 ± 2.3 vs. 0.7 ± 1.3 mm2, p = 0.02). As a result, the enlargement of the lumen area tended to be larger in the calcified group (2.8 ± 1.7 vs. 2.4 ± 1.3 mm2, p = 0.3). Calcified nodule-like neointima within the stent could develop in approximately 10% of all ISR lesions, especially within stents deployed in severely calcified lesions.

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Acknowledgements

The authors thank the staffs in the catheterization laboratory at Red Cross Kyoto Daini Hospital for their excellent assistance during the study.

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Authors and Affiliations

  1. Department of Cardiology, Japanese Red Cross Kyoto Daini Hospital, Kyoto, Japan

    Koji Isodono, Tomotaka Fujimoto, Takeru Kasahara, Makoto Ariyoshi, Daisuke Irie, Yoshinori Tsubakimoto, Tomohiko Sakatani, Akiko Matsuo, Keiji Inoue & Hiroshi Fujita

  2. Division of Cardiology, Department of Medicine II, Kansai Medical University, Hirakata, Japan

    Kenichi Fujii

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  1. Koji Isodono
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  2. Kenichi Fujii
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  3. Tomotaka Fujimoto
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  4. Takeru Kasahara
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  5. Makoto Ariyoshi
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  6. Daisuke Irie
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  7. Yoshinori Tsubakimoto
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  11. Hiroshi Fujita
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Correspondence to Koji Isodono.

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This study was conducted in agreement with the Declaration of Helsinki and was approved by the institutional ethics committee.

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Isodono, K., Fujii, K., Fujimoto, T. et al. The frequency and clinical characteristics of in-stent restenosis due to calcified nodule development after coronary stent implantation. Int J Cardiovasc Imaging 37, 15–23 (2021). https://doi.org/10.1007/s10554-020-01952-z

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  • DOI: https://doi.org/10.1007/s10554-020-01952-z

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