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European Heart Journal 2004 25(1):32-38; doi:10.1016/j.ehj.2003.10.012
Copyright © 2004 by the European Society of Cardiology.
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Clinical research

Intravascular ultrasound evaluation after sirolimus eluting stent implantation for de novo and in-stent restenosis lesions

Muzaffer Degertekina, Pedro A. Lemosa, Chi Hang Leea, Kengo Tanabea, J.Eduardo Sousab, Alexandre Abizaidb, Evelyn Regara, George Sianosa, Willem J. van der Giessena, Pim J. de Feytera, Egon Wuelfertc, Jeffrey J. Popmad and Patrick W. Serruysa,*

a Erasmus Medical Center, Department of Cardiology, Thoraxcenter, Rotterdam, The Netherlands
b Institute Dante Pazzanese Cardiology, São Paulo, Brazil
c Cordis Corporation Brussels, Brussels, Belgium
d Brigham and Women's Hospital, Boston, MA, USA

* Correspondence to: Prof. P. W. Serruys MD, Ph.D., Head of Interventional Department, Erasmus MC, Thoraxcentre, Bd. 408, Dr. Molewaterplein 40, 3015 GD Rotterdam, The Netherlands. Tel: +31 10 463 5260; Fax: +31 10 436 9154
E-mail address: serruys{at}card.azr.nl

Received 9 December 2002; revised 1 October 2003; accepted 16 October 2003

Abstract

Aims The aim of this study is to compare the efficacy of sirolimus-eluting stents (SES) on neointimal growth and vessel remodelling for in-stent restenosis versus de novo coronary artery lesions using serial intravascular ultrasound (IVUS).

Methods and results The study population consisted of 86 patients with in-stent restenosis (ISR) (n=41) or de novo lesions (n=45) treated with SES and evaluated by IVUS post-procedure and at follow-up. One 18-mm SES was used for de novo lesions while 16 patients with ISR received >1SES (total stented length 17.9mm vs 22.0mm respectively; P=0.004). At follow-up, no differences were observed between the ISR and de novo groups with respect to changes in the mean external elastic membrane (1.7% vs 1.3%; P=0.53), plaque behind the stent (1.2% vs 3.4%; P=0.49), and lumen areas (0.7% vs 1.9%; P=0.58). No positive remodelling or edge effect was observed. A gap between stents was observed in two patients with ISR, where more prominent, though non-obstructive, neointimal proliferation was noted.

Conclusion Sirolimus-eluting stenting is equally effective at inhibiting neointimal proliferation in de novo and ISR lesions without inducing edge restenosis or positive vascular remodelling.

Key Words: Sirolimus • Stent • Ultrasound • Restenosis


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