From the Intravascular Ultrasound Imaging and Cardiac Catheterization
Laboratories, Washington Hospital Center, Washington, DC.
Correspondence to Martin B. Leon, MD, Cardiology Research Foundation, 110 Irving St, NW, 4B1, Washington, DC 20010.
Abstract
Background—Mechanisms of
recurrence after treatment of in-stent restenosis
are unknown.
Methods and Results—We prospectively performed quantitative
coronary angiography (QCA) and intravascular ultrasound (IVUS)
in 37 lesions with Palmaz-Schatz stents enrolled in a study of
intracoronary radiation for in-stent restenosis.
Primary treatment was at the discretion of the operator: PTCA (n=8) or
ablation+adjunct PTCA (n=29). Lesions were studied before intervention,
immediately after primary intervention, and 42±8 minutes later. QCA
measurements included minimal luminal diameter and diameter
stenosis. Planar IVUS measurements included
arterial, stent, lumen, and in-stent tissue areas. Stent,
lumen, and in-stent tissue volumes were calculated by use of Simpson's
rule. Compared with immediately after intervention, the delayed (42±8
minutes) minimal lumen area decreased by 20% (5.8±1.9 to
4.5±1.3 mm2, P<0.0001) and the lumen
volume by 12% (58±41 to 52±37 mm3,
P=0.0001). Ten lesions (27%) had a
Conclusions—There is significant tissue reintrusion shortly after
catheter-based treatment of in-stent restenosis. This was
greater in longer lesions and those with a larger in-stent tissue
burden, was not reflected in the QCA measurements, and may contribute
to recurrence.
© 1998 American Heart Association, Inc.
Brief Rapid Communication
Early Lumen Loss After Treatment of In-Stent Restenosis
An Intravascular Ultrasound Study
2.0-mm2 decrease in minimum lumen area. Lumen loss (1)
resulted from increased tissue with the stent, (2) correlated with
lesion length and preintervention in-stent tissue, and (3) was not seen
angiographically.
Key Words: restenosis • stents • ultrasonics
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