Skip Navigation

European Heart Journal 2001 22(21):2015-2024; doi:10.1053/euhj.2001.2609
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 (9)
Right arrowRequest Permissions
Right arrow Disclaimer
Google Scholar
Right arrow Articles by Hoffmann, R.
Right arrow Articles by Hanrath, P.
Right arrow Search for Related Content
PubMed
Right arrow PubMed Citation
Right arrow Articles by Hoffmann, R.
Right arrow Articles by Hanrath, P.
Social Bookmarking
Add to CiteULike   Add to Connotea   Add to Del.icio.us  
What's this?

The impact of high pressure vs low pressure stent implantation on intimal hyperplasia and follow-up lumen dimensions; results of a randomized trial

R. Hoffmanna, P. Haagera, G.S. Mintzb, G. Kerckhoffa, R. Schwarza, A. Frankea, J. Vom Dahla and P. Hanratha

a Medical Clinic I, University RWTH Aachen, Aachen, Germany
b Washington Hospital Center, Washington, DC, U.S.A.

revised January 12, 2001; accepted January 17, 2001

Abstract

Aims Histology and retrospective clinical studies have indicated that the amount of neointimal hyperplasia is dependent on the arterial injury induced during stent implantation. This study analysed, prospectively, the impact of high vs low pressure stent implantation techniques using a second generation stent on intimal hyperplasia and follow-up lumen dimensions.

Methods and Results Post-intervention and follow-up (mean[±SD] 5·5±1·3 months) angiographic and intravascular ultrasound studies were performed on 120 Multi-Link HP stents randomized to implantation at either low (8–10atm) or high (16–20atm) pressure. Intravascular ultrasound measurements of the external elastic membrane, stent, and lumen cross-sectional area were performed at 1mm axial increments. Peri-stent plaque+media cross-sectional area (external elastic membrane–stent cross-sectional area, intimal hyperplasia cross-sectional area (stent–lumen cross-sectional area at follow-up), intimal hyperplasia thickness and peri-stent tissue growth cross-sectional area ({Delta}persistent plaque+media cross-sectional area) were calculated. Intravascular ultrasound demonstrated a larger minimal lumen cross-sectional area post-intervention in the high pressure group (7·3±2·0 vs 6·2±1·8mm2, P<0·001, high vs low pressure group, respectively). At follow-up, the mean intimal hyperplasia cross-sectional area (1·7±0·9 vs 1·5±0·8mm2, P=0·708), the mean intimal hyperplasia thickness (0·16±0·12 vs 0·16±0·12mm,P =0·818) and peri-stent tissue proliferation cross-sectional area were not greater in the high pressure group. Thus, the minimal lumen cross-sectional area at follow-up continued to be greater (5·5±2·0 vs 4·7±1·7mm2, P=0·038) in the high pressure group.

Conclusions High pressure stent implantation results in greater stent expansion even with the less rigid second generation Multi-Link stent. Larger lumen dimensions persist at follow-up, while intimal hyperplasia is not significantly greater after high pressure implantation compared to the low pressure technique.

Key Words: Angioplasty, restenosis, stents, ultrasonics

Correspondence: Rainer Hoffmann, FESC, Medical Clinic I, University RWTH Aachen, Pauwelsstrasse 30, 52057 Aachen, Germany.

References

  1. Colombo A, Hall P, Nakamura S. Intracoronary stenting without anticoagulation accomplished with intravascular ultrasound guidance. Circulation. 1995;91:1676–1688[Abstract/Free Full Text]
  2. Goldberg SL, Colombo A, Nakamura S. Benefit of intracoronary ultrasound in the deployment of Palmaz–Schatz Stents. J Am Coll Cardiol. 1994;24:996–1003[Abstract]
  3. Schömig A, Neumann FJ, Kastrati A. A randomized comparison of antiplatelet and anticoagulation therapy after the placement of coronary-artery stents. N Engl J Med. 1996;334:1084–1089[Abstract/Free Full Text]
  4. Hoffmann R, Mintz GS, Dussaillant GR. Patterns and mechanisms of instent restenosis: A serial intravascular ultrasound study. Circulation. 1996;94:1247–1254[Abstract/Free Full Text]
  5. 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]
  6. Schwartz RS, Huber KC, Murphy JG. Restenosis and the proportional neointimal response to coronary artery injury: results in a porcine model. J Am Coll Cardiol. 1992;19:267–274[Abstract]
  7. Farb A, Sangiorgi G, Carter AJ. Pathology of acute and chronic coronary stenting in humans. Circulation. 1999;99:44–52[Abstract/Free Full Text]
  8. Savage MP, Fischman DL, Douglas JS. The dark side of high pressure stent deployment (Abstr). J Am Coll Cardiol. 1997;29:368
  9. Fernandez-Aviles F, Alonso JJ, Duran JM. High pressure increases late loss after coronary stenting (Abstr). J Am Coll Cardiol. 1997;29:369
  10. Dirschinger J, Kastrati A, Neumann FJ. Influence of balloon pressure during stent placement in native coronary arteries on early and late angiographic and clinical outcome. Circulation. 1999;100:918–923[Abstract/Free Full Text]
  11. Stone GW, St. Goar FR, Hodgson JMcB. Analysis of the relation between stent implantation pressure and expansion. Am J Cardiol. 1999;83:1397–1400[CrossRef][Web of Science][Medline]
  12. Carrozza JP, Hermiller JB, Linnemeier TJ. Quantitative coronary angiographic and intravascular ultrasound assessment of a new nonarticulated stent: report from the advanced cardiovascular systems MultiLink stent pilot study. J Am Coll Cardiol. 1998;31:50–56[Abstract/Free Full Text]
  13. Hoffmann R, Mintz GS, Mehran R. Intravascular ultrasound for prediction of angiographic restenosis in lesions treated with Palmaz-Schatz Stents. J Am Coll Cardiol. 1998;31:43–49[Abstract/Free Full Text]
  14. Fitzgerald PJ, Oshima A, Hayase M. Final results of the Can Routine Ultrasound Influence Stent Expansion (CRUISE) study. Circulation. 2000;102:523–528[Abstract/Free Full Text]
  15. De Feyter PJ, Kay P, Disco C. Reference chart derived from post-stent-implantation intravascular ultrasound predictors of 6-month expected restenosis on quantitative coronary angiography. Circulation. 1999;100:1777–1783[Abstract/Free Full Text]
  16. 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][Web of Science][Medline]
  17. 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]
  18. Chesebro JH, Knatterud G, Roberts R. Thrombolysis in Myocardial Infarction (TIMI) Trial. Phase I: a comparison between intravenous tissue plasminogen activator and intravenous streptokinase: clinical findings through hospital discharge. Circulation. 1987;76:142–154[Abstract/Free Full Text]
  19. 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;84:1087–1099[Abstract/Free Full Text]
  20. Tobis JM, Mallery J, Mahon D. Intravascular ultrasound imaging of human coronary arteries in vivo analysis of tissue characterization with comparison to in vitro histological specimens. Circulation. 1991;83:913–926[Abstract/Free Full Text]
  21. Hoffmann R, Mintz GS, Popma JJ. Chronic arterial responses to stent implantation: A serial intravascular ultrasound analysis of Palmaz-Schatz stents in native coronary arteries. J Am Coll Cardiol. 1996;28:1134–1139[Abstract]
  22. Mintz GS, Griffin J, Chuang YC. The reproducibility of the intravascular ultrasound assessment of stent implantation in saphenous vein grafts. Am J Cardiol. 1995;75:1267–1270[CrossRef][Web of Science][Medline]
  23. Kornowski R, Hong MK, Tio FO. 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]
  24. Stratiev V, Chevalier B, Glatt B. Does systematic high pressure deployment improve clinical outcome after Palmaz-Schatz coronary stent implantation? (Abstr). J Am Coll Cardiol. 1998;31:17
  25. Prati F, Di Mario C, Moussa I. In-stent neointimal proliferation correlates with the amount of residual plaque burden outside the stent. Circulation. 1999;99:1011–1014[Abstract/Free Full Text]
  26. Goldberg SL, Di Mario C, Hall P. Comparison of aggressive versus nonaggressive balloon dilatation for stent deployment on late loss and restenosis in native arteries. Am J Cardiol. 1998;81:708–712[CrossRef][Web of Science][Medline]
  27. Rogers C, Edelman ER. Endovascular stent design dictates experimental restenosis and thrombosis. Circulation. 1995;91:2995–3001[Abstract/Free Full Text]

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
 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 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 (9)
Right arrowRequest Permissions
Right arrow Disclaimer
Google Scholar
Right arrow Articles by Hoffmann, R.
Right arrow Articles by Hanrath, P.
Right arrow Search for Related Content
PubMed
Right arrow PubMed Citation
Right arrow Articles by Hoffmann, R.
Right arrow Articles by Hanrath, P.
Social Bookmarking
Add to CiteULike   Add to Connotea   Add to Del.icio.us  
What's this?