Skip Navigation

European Heart Journal 2001 22(21):2007-2014; doi:10.1053/euhj.2001.2606
Copyright © 2001 by the European Society of Cardiology.
This Article
Right arrow Abstract Freely available
Right arrow Full Text (PDF)
Right arrow Alert me when this article is cited
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 (20)
Right arrowRequest Permissions
Google Scholar
Right arrow Articles by Hoffmann, R.
Right arrow Articles by Mudra, H.
Right arrow Search for Related Content
PubMed
Right arrow PubMed Citation
Right arrow Articles by Hoffmann, R.
Right arrow Articles by Mudra, H.
Social Bookmarking
Add to CiteULike   Add to Connotea   Add to Del.icio.us  
What's this?

Stent design related neointimal tissue proliferation in human coronary arteries; an intravascular ultrasound study

R. Hoffmanna,f1, C. Jansena, A. Königb, P.K. Haagera, G. Kerckhoffa, J. Vom Dahla, V. Klaussb, P. Hanratha and H. Mudrac

a Medical Clinic I, University Clinic RWTH Aachen, Aachen, Germany
b Department of Internal Medicine, Division of Cardiology, Department of Cardiology, University Munich, Munich, Germany
c Department of Cardiology, Krankenhaus Neuperlach, Munich, Germany

revised January 12, 2001; accepted January 17, 2001

Abstract

Aims Histological restenosis models in animals have indicated that stent design has a significant impact on vessel trauma during stent implantation and on the amount of subsequent neointimal tissue proliferation. The impact of different stent designs on intimal hyperplasia in human atherosclerotic coronary arteries has not been determined.

Methods and Results Angiographic and intravascular ultrasound studies were performed at the 6 month follow-up in 131 consecutive native coronary lesions of 131 patients treated with 50 Multi-LinkTM stents, 40 InFlowTM stents and 41 Palmaz–SchatzTM stents. Lumen and stent cross-sectional areas (CSA) were measured at 1mm axial increments. Mean intimal hyperplasia cross-sectional area (stent CSA–lumen CSA) and mean intimal hyperplasia thickness were calculated. Intravascular ultrasound demonstrated different levels of intimal hyperplasia proliferation for the three stents. Mean intimal hyperplasia thickness was 0·16±0·08mm for Multi-Link stents, 0·26±0·19mm for Palmaz–Schatz stents and 0·39±0·14mm for Inflow stents (P<0·001). Multivariate analysis proved that stent type was the only independent predictor of intimal hyperplasia thickness at follow-up (P<0·001).

Conclusion Coronary stent design has a significant impact on subsequent intimal hyperplasia after implantation into atherosclerotic human coronary arteries. The corrugated ring design of the Multi-Link stent proved to result in less tissue proliferation at 6-month follow-up than the tubular slotted design of Palmaz–Schatz and InFlow stents.

Key Words: Intimal hyperplasia, intravascular ultrasound, restenosis, stent

f1 Correspondence: Rainer Hoffmann, MD, FESC, Medical Clinic I, Klinikum RWTH Aachen, Pauwelsstraße, 52057 Aachen, Germany.

References

  1. Hoffmann R, Mintz GS, Dussaillant GR. Patterns and mechanisms of in-stent restenosis: A serial intravascular ultrasound study. Circulation. 1996;94:1247–1254[Abstract/Free Full Text]
  2. Mudra H, Regar E, Klauss V. Serial follow-up after optimized ultrasound-guided deployment of Palmaz-Schatz stents. Circulation. 1997;95:363–370[Abstract/Free Full Text]
  3. Kornowski R, Hong MK. In-stent restenosis: contributions of inflammatory responses and arterial injury to neointimal hyperplasia. J Am Coll Cardiol. 1998;31:224–230[Abstract/Free Full Text]
  4. Schwartz RS, Huber KC, Murphy JG. Restenosis and proportional neointimal response to coronary artery injury: results in a porcine model. J Am Coll Cardiol. 1992;19:267–274[Abstract]
  5. Rogers C, Edelman ER. Endovascular stent design dictates experimental restenosis and thrombosis. Circulation. 1995;91:2995–3001[Abstract/Free Full Text]
  6. Barth KH, Virmani R, Froelich J. Paired comparison of vascular wall reactions to Palmaz stents, Strecker tantalum stents, and Wallstents in canine iliac and femoral arteries. Circulation. 1996;93:2161–2169[Abstract/Free Full Text]
  7. Fishman D, Leon M, Baim D. A randomized comparison of coronary stent placement and balloon angioplasty in the treatment of coronary artery disease. N Engl J Med. 1994;331:496–501[Abstract/Free Full Text]
  8. Serruys PW, de Jaegere P, Kiemeneij F. A comparison of balloon expandable stent implantation with balloon angioplasty in patients with coronary artery disease. N Engl J Med. 1994;331:489–495[Abstract/Free Full Text]
  9. Dirschinger J, Kastrati A, Boekstegers P. Influence of stent design on one-year outcome after coronary stent placement: a multicentre randomized trial with five stent types. Eur Heart J. 1999;20:3262A
  10. Popma JJ, Curran MJ, Abizaid AS. Early quantitative angiographic outcomes in the randomized ACS Multilink stent vs Palmaz-Schatz coronary stent trial for the treatment of de novo coronary lesions. Circulation. 1997;96:I-593
  11. Baim DS, Cutlip DE, Lansky AJ, Ricci GB, Fitzpatrick M. Results of the Nirvana equivalency trial comparing the NIR Primo stent to the Palmaz-Schatz stent. Circulation. 1998;98:I-661
  12. Leon MB, Popma JJ, O'Shaughnessy C. Quantitative angiographic outcomes after Gianturco-Roubin stent implantation in complex lesion subsets. Circulation. 1997;96:I-593
  13. Mehran R, Mintz GS, Hong MK. Validation of the in vivo intravascular ultrasound measurement of in-stent neointimal hyperplasia volumes. J Am Coll Cardiol. 1998;32:794–799[Abstract/Free Full Text]
  14. Nakamura S, Colombo A, Gaglione A. Intracoronary ultrasound observations during stent implantation. Circulation. 1994;89:2026–2034[Free Full Text]
  15. Hoffmann R, Mintz GS, Popma JJ. Overestimation of acute lumen gain and late lumen loss by quantitative coronary angiography (compared with intravascular ultrasound) in stented lesions. Am J Cardiol. 1997;80:1277–1281[CrossRef][ISI][Medline]
  16. de Jaegere P, Mudra H, Figulla H. Intravascular ultrasound-guided optimized stent deployment. Eur Heart J. 1998;19:1214–1223[Abstract/Free Full Text]
  17. Nishimura RA, Edwards WD, Warnes CA. Intravascular ultrasound imaging: in vitro validation and pathologic correlation. J Am Coll Cardiol. 1990;16:145–154[Abstract]
  18. Nissen S, Gurley J, Grines CL. Intravascular ultrasound assessment of lumen size and wall morphology in normal subjects and patients with coronary artery disease. Circulation. 1991;84:1087[Abstract/Free Full Text]
  19. Rogers C, Tseng DY, Squire JC, Edelman ER. Balloon-artery interactions during stent placement. Circ Res. 1999;84:378–383[Abstract/Free Full Text]
  20. Garasic JM, Edelman ER, Squire JC, Seifert P, Williams MS, Rogers C. Stent and artery geometry determine intimal thickening independent of arterial injury. Circulation. 2000;101:812–818[Abstract/Free Full Text]
  21. Serruys PW, Emanuelsson H, van der Giessen W. Heparin-coated Palmaz-Schatz stents in human coronary arteries. Early outcome of the Benestent-II Pilot study. Circulation. 1996;93:412–422[Abstract/Free Full Text]
  22. Emanuelsson H, Serruys PW, van der Giessen W. Clinical and angiographic results with the Multi-Link coronary stent system—the West European Stent Trial. J Invas Cardiol. 1997;9:561–568[ISI][Medline]
  23. Serruys PW, van der Giessen W, Garcia E. Clinical and angiographic results with the Multi-Link stent implanted under intravascular ultrasound guidance (WEST 2 study). J Invas Cardiol. 1998;10:20B–27B
  24. Kastrati A, Schömig A, Dirschinger J. Increased risk of restenosis after placement of gold-coated stents. Circulation. 2000;101:2478–2483[Abstract/Free Full Text]
  25. Kastrati A, Schömig A, Elezi S. Predictive factors of restenosis after coronary stent placement. J Am Coll Cardiol. 1997;30:1428–1436[Abstract]
  26. Hoffmann R, Mintz GS, Pichard AD. Intimal hyperplasia thickness at follow-up is independent of stent size. A serial intravascular ultrasound study. Am J Cardiol. 1998;82:1168–1172[CrossRef][ISI][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. Clin. Pathol.Home page
J Butany, K Carmichael, S W Leong, and M J Collins
Coronary artery stents: identification and evaluation
J. Clin. Pathol., August 1, 2005; 58(8): 795 - 804.
[Abstract] [Full Text] [PDF]

Home page
 CirculationHome page
A. J. Chaves, A. G.M.R. Sousa, L. A. Mattos, A. Abizaid, R. Staico, F. Feres, M. Centemero, L. F. Tanajura, A. Abizaid, I. Pinto, et al.
Volumetric Analysis of In-Stent Intimal Hyperplasia in Diabetic Patients Treated With or Without Abciximab: Results of the Diabetes Abciximab steNT Evaluation (DANTE) Randomized Trial
Circulation, February 24, 2004; 109(7): 861 - 866.
[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
M. N. Babapulle and M. J. Eisenberg
Coated Stents for the Prevention of Restenosis: Part II
Circulation, November 26, 2002; 106(22): 2859 - 2866.
[Full Text] [PDF]

Home page
 Eur Heart JHome page
S. Windecker and B. Meier
All stents are not alike or is the difference in the eye of the observer only?
Eur. Heart J., November 1, 2001; 22(21): 1973 - 1977.
[PDF]

This Article
Right arrow Abstract Freely available
Right arrow Full Text (PDF)
Right arrow Alert me when this article is cited
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 (20)
Right arrowRequest Permissions
Google Scholar
Right arrow Articles by Hoffmann, R.
Right arrow Articles by Mudra, H.
Right arrow Search for Related Content
PubMed
Right arrow PubMed Citation
Right arrow Articles by Hoffmann, R.
Right arrow Articles by Mudra, H.
Social Bookmarking
Add to CiteULike   Add to Connotea   Add to Del.icio.us  
What's this?