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European Heart Journal 2001 22(15):1311-1317; doi:10.1053/euhj.2000.2542
Copyright © 2001 by the European Society of Cardiology.
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The pattern of restenosis and vascular remodelling after cold-end adioactive stent implantation

I. P. Kaya, A. J. Wardeha, K. Kozumaa, G. Sianosa, E. Regara, M. Knooka, W. J. van der Giessena, A. Thurya, J. M. R. Ligtharta, V. M. A. Coenb, P. C. Levendagb and P. W. Serruysa,f1

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: {Delta} neointimal hyperplasia=3·72mm3(8·6%); in-stent at the edges of radiation proximally and distally {Delta} 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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