Published Online
on March 1, 2004

A more recent version of this article appeared on March 9, 2004

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Submitted on December 1, 2003
Revised on January 16, 2004
Accepted on January 22, 2004

Contribution of Stent Underexpansion to Recurrence After Sirolimus-Eluting Stent Implantation for In-Stent Restenosis

Kenichi Fujii MD, Gary S. Mintz MD, Yoshio Kobayashi MD, Stéphane G. Carlier MD, PhD, Hideo Takebayashi MD, Takenori Yasuda MD, Issam Moussa MD, George Dangas MD, PhD, Roxana Mehran MD, Alexandra J. Lansky MD, Arlene Reyes MD, Edward Kreps MD, Michael Collins MD, Antonio Colombo MD, Gregg W. Stone MD, Paul S. Teirstein MD, Martin B. Leon MD, and Jeffrey W. Moses MD^*

From the Cardiovascular Research Foundation, Lenox Hill Heart and Vascular Institute, New York, NY.

^* To whom correspondence should be addressed. E-mail: jmoses{at}lenoxhill.net.

Background--We used intravascular ultrasound (IVUS) to evaluate recurrence after sirolimus-eluting stent (SES) implantation treatment of in-stent restenosis (ISR).

Methods and Results--Forty-eight ISR lesions (41 patients with objective evidence of ischemia) were treated with SES. Recurrent ISR was identified in 11 lesions (all focal); repeat revascularization was performed in 10. These were compared with 16 patients (19 lesions) without recurrence as documented by angiography. Nine of 11 recurrent lesions had a minimum stent area (MSA) <5.0 mm² versus 5 of 19 nonrecurrent lesions (P=0.003); 7 of 11 recurrent lesions had an MSA <4.0 mm² versus 4 of 19 nonrecurrent lesions (P=0.02); and 4 of 11 recurrent lesions had an MSA <3.0 mm² versus 1 of 19 nonrecurrent lesions (P=0.03). A gap between SESs was identified in 3 of 11 recurrences versus 1 of 19 nonrecurrent lesions.

Conclusions--Stent underexpansion is a significant cause of failure after SES implantation treatment of ISR.

Key words: ultrasonics • restenosis • stents

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