Copyright © 2004 by the European Society of Cardiology.
Clinical research
Intravascular ultrasound evaluation after sirolimus eluting stent implantation for de novo and in-stent restenosis lesions
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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