Copyright © 2001 by the European Society of Cardiology.
The pattern of restenosis and vascular remodelling after cold-end adioactive stent implantation
a Thoraxcenter, Rotterdam, The Netherlands
b Daniel den Hoed Cancer Center, Rotterdam, The Netherlands
revised November 7, 2000; accepted November 22, 2000
Abstract
Background Edge restenosis is a major problem after radioactive stenting. The cold-end stent has a radioactive mid-segment (15·9mm) and non-radioactive proximal and distal 5·7mm segments. Conceptually this may negate the impact of negative vascular remodelling at the edge of the radiation.
Method and Results ECG-gated intravascular ultrasound with three-dimensional reconstruction was performed post-stent implantation and at the 6-month follow-up to assess restenosis within the margins of the stent and at the stent edges in 16 patients. Angiographic restenosis was witnessed in four patients, all in the proximal in-stent position. By intravascular ultrasound in-stent neointimal hyperplasia, with a >50% stented cross-sectional area, was seen in eight patients. This was witnessed proximally (n=2), distally (n=2) and in both segments (n=4). Echolucent tissue, dubbed the ‘black hole’ was seen as a significant component of neointimal hyperplasia in six out of the eight cases of restenosis. Neointimal hyperplasia was inhibited in the area of radiation: 
neointimal hyperplasia=3·72mm3(8·6%); in-stent at the edges of radiation proximally and distally neointimal hyperplasia was 7·9mm3(19·0%) and 11·4mm3(25·6%), respectively (P=0·017). At the stent edges there was no significant change in lumen volume.
Conclusions Cold-end stenting results in increased neointimal hyperplasia in in-stent non-radioactive segments.
Key Words: Stents, remodelling, radioisotopes, angioplasty, ultrasonics
f1 Correspondence: P. W. Serruys, MD, PhD, FACC, FESC, Professor of Interventional Cardiology, Thoraxcenter, Academisch Ziekenhuis Rotterdam, PO Box 1738, Dr. Molewaterplein 40, 3000 DR Rotterdam, The Netherlands.
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