Skip Navigation

European Heart Journal 2001 22(15):1311-1317; doi:10.1053/euhj.2000.2542
Copyright © 2001 by the European Society of Cardiology.
This Article
Right arrow Abstract Freely available
Right arrow FREE Full Text (PDF) Freely available
Right arrow E-letters: Submit a response
Right arrow Alert me when this article is cited
Right arrow Alert me when E-letters are posted
Right arrow Alert me if a correction is posted
Services
Right arrow Email this article to a friend
Right arrow Similar articles in this journal
Right arrow Similar articles in ISI Web of Science
Right arrow Similar articles in PubMed
Right arrow Alert me to new issues of the journal
Right arrow Add to My Personal Archive
Right arrow Download to citation manager
Right arrow Search for citing articles in:
ISI Web of Science (11)
Right arrowRequest Permissions
Right arrow Disclaimer
Google Scholar
Right arrow Articles by Kay, I. P.
Right arrow Articles by Serruys, P. W.
Right arrow Search for Related Content
PubMed
Right arrow PubMed Citation
Right arrow Articles by Kay, I. P.
Right arrow Articles by Serruys, P. W.
Social Bookmarking
Add to CiteULike   Add to Connotea   Add to Del.icio.us  
What's this?

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.

References

  1. Farb A, Sangiorgi G, Carter AJ. Pathology of acute and chronic coronary stenting in humans. Circulation. 1999;99:44–52[Abstract/Free Full Text]
  2. Murphy JG, Schwartz RS, Edwards WD. Percutaneous polymeric stents in porcine coronary arteries. Initial experience with polyethylene terephthalate stents. Circulation. 1992;86:1596–1604[Abstract/Free Full Text]
  3. Wardeh AJ, Kay IP, Sabaté M. ß-particle-emitting radioactive stent implantation: a safety and feasibility study. Circulation. 1999;100:1684–1689[Abstract/Free Full Text]
  4. Albiero R, Adamian M, Kobayashi N. Short- and intermediate-term results of32P radioactive ß-emitting stent implantation in patients with coronary artery disease: the Milan Dose-Response Study. Circulation. 2000;101:18–26[Abstract/Free Full Text]
  5. Kay IP, Sabaté M, Costa MA. Positive geometric vascular remodeling is seen after catheter-based radiation followed by conventional stent implantation, but not after radioactive stent implantation. Circulation. 2000;102:1434–1439[Abstract/Free Full Text]
  6. von Birgelen C, Mintz GS, Nicosia A. Electrocardiogram-gated intravascular ultrasound image acquisition after coronary stent deployment facilitates on-line three-dimensional reconstruction and automated lumen quantification. J Am Coll Cardiol. 1997;30:436–443[Abstract]
  7. Bland JM, Altman DG. Some examples of regression towards the mean. BMJ. 1994;309:780[Free Full Text]
  8. von Birgelen C, de Feyter PJ, de Vrey EA. Simpson's rule for the volumetric ultrasound assessment of atherosclerotic coronary arteries: a study with ECG-gated three-dimensional intravascular ultrasound. Coron Artery Dis. 1997;6:363–369
  9. von Birgelen C, Di Mario C, Li W. Morphometric analysis in three-dimensional intracoronary ultrasound: an in vitro and in vivo study performed with a novel system for the contour detection of lumen and plaque. Am Heart J. 1996;132:516–527[CrossRef][Web of Science][Medline]
  10. Prati F, Di Mario C, Moussa I. In-stent neointimal proliferation correlates with the amount of residual plaque burden outside the stent. An intravascular ultrasound study. Circulation. 1999;99:1011–1014[Abstract/Free Full Text]
  11. Paterson R. The treatment of malignant disease by radiotherapy. London: Edward Arnold Publishers Ltd; 1963.
  12. Serruys PW, Kay IP. I like the candy, I hate the wrapper. Circulation. 2000;101:3–7[Free Full Text]
  13. Kay IP, Sabaté M, Ligthart JMR, van der Giessen WJ, de Feyter PJ, Serruys PW. Intracoronary ultrasound longitudinal reconstruction of a postangioplasty coronary artery dissection. Circulation. 1999;99:e17[Free Full Text]
  14. Serrano P, Kross JM, Ligthart JMR, Costa MA, Sabaté M, de Feyter PJ. Diagnosis of an intracoronary thrombus with intravascular ultrasound. Circulation. 2000;101:e84–e85[Free Full Text]
  15. Gronholdt M-LM, Nordestgaard BG, Wiebe BM, Wilhjelm JE, Sillesen H. Echolucency of computerized ultrasound images of carotid atherosclerotic plaques are associated with increased levels of triglyceride-rich lipoproteins as well as increased plaque lipid content. Circulation. 1998;97:34–40[Abstract/Free Full Text]
  16. Carter AJ, Scott D, Bailey L, Hoopes T, Jones R, Virmani R. Dose-response effects in an atherosclerotic porcine coronary model. Circulation. 1999;100:1548–1554[Abstract/Free Full Text]
  17. Hehrlein C, Kaiser S, Riessen R, Metz J, Fritz P, Kübler W. External beam radiation after stent implantation increases neointimal hyperplasia by augmenting smooth muscle cell proliferation and extracellular matrix accumulation. J Am Coll Cardiol. 1999;34:561–566[Abstract/Free Full Text]
  18. Hoffmann R, Mintz GS, Dussaillant GR. Patterns and mechanism of in-stent restenosis. A serial intravascular ultrasound study. Circulation. 1996;94:1247–1254[Abstract/Free Full Text]
  19. Weinberger J, Amols H, Ennis RD, Schwartz A, Wiedermann JG, Marboe C. Intracoronary irradiation: Dose response for the prevention of restenosis in swine. Int J Radiation Oncology Biol Phys. 1996;36:767–775[CrossRef][Web of Science][Medline]

Add to CiteULike CiteULike   Add to Connotea Connotea   Add to Del.icio.us Del.icio.us    What's this?


This article has been cited by other articles:


Home page
 J Am Coll CardiolHome page
M. Degertekin, E. Regar, K. Tanabe, P. C. Smits, W. J. van der Giessen, S. G. Carlier, P. de Feyter, J. Vos, D. P. Foley, J. M. R. Ligthart, et al.
Sirolimus-eluting stent for treatment of complex in-stent restenosis: The first clinical experience
J. Am. Coll. Cardiol., January 15, 2003; 41(2): 184 - 189.
[Abstract] [Full Text] [PDF]

Home page
 Eur Heart JHome page
V. Spanos, G. Stankovic, J. Tobis, and A. Colombo
The challenge of in-stent restenosis: insights from intravascular ultrasound
Eur. Heart J., January 2, 2003; 24(2): 138 - 150.
[Full Text] [PDF]

Home page
 CirculationHome page
P. W. Serruys, M. Degertekin, K. Tanabe, A. Abizaid, J. E. Sousa, A. Colombo, G. Guagliumi, W. Wijns, W. K. Lindeboom, J. Ligthart, et al.
Intravascular Ultrasound Findings in the Multicenter, Randomized, Double-Blind RAVEL (RAndomized study with the sirolimus-eluting VElocity balloon-expandable stent in the treatment of patients with de novo native coronary artery Lesions) Trial
Circulation, August 13, 2002; 106(7): 798 - 803.
[Abstract] [Full Text] [PDF]

Home page
 CirculationHome page
J. E. Sousa, M. A. Costa, and A. G.M.R. Sousa
What Is "The Matter" With Restenosis in 2002?
Circulation, June 25, 2002; 105(25): 2932 - 2933.
[Full Text] [PDF]

Home page
 CirculationHome page
A.J. Wardeh, R. Albiero, I.P. Kay, A.H.M. Knook, W. Wijns, K. Kozuma, T. Nishida, V. Ferrero, P.C. Levendag, W.J. van der Giessen, et al.
Angiographical Follow-Up After Radioactive "Cold Ends" Stent Implantation: A Multicenter Trial
Circulation, February 5, 2002; 105(5): 550 - 553.
[Abstract] [Full Text] [PDF]

Home page
 Eur Heart JHome page
A. Arab, C. Bode, and C. Hehrlein
The radioactive stent -- any chance of a resurrection?
Eur. Heart J., August 1, 2001; 22(15): 1245 - 1247.
[Abstract] [PDF]

This Article
Right arrow Abstract Freely available
Right arrow FREE Full Text (PDF) Freely available
Right arrow E-letters: Submit a response
Right arrow Alert me when this article is cited
Right arrow Alert me when E-letters are posted
Right arrow Alert me if a correction is posted
Services
Right arrow Email this article to a friend
Right arrow Similar articles in this journal
Right arrow Similar articles in ISI Web of Science
Right arrow Similar articles in PubMed
Right arrow Alert me to new issues of the journal
Right arrow Add to My Personal Archive
Right arrow Download to citation manager
Right arrow Search for citing articles in:
ISI Web of Science (11)
Right arrowRequest Permissions
Right arrow Disclaimer
Google Scholar
Right arrow Articles by Kay, I. P.
Right arrow Articles by Serruys, P. W.
Right arrow Search for Related Content
PubMed
Right arrow PubMed Citation
Right arrow Articles by Kay, I. P.
Right arrow Articles by Serruys, P. W.
Social Bookmarking
Add to CiteULike   Add to Connotea   Add to Del.icio.us  
What's this?