Various optical coherence tomographic findings in restenotic lesions after sirolimus-eluting stent implantation.
ABSTRACT In-stent restenosis (ISR) after sirolimus-eluting stent (SES) implantation rarely occurs, and these lesions are commonly recognized as focal restenosis on angiograms. Optical coherence tomography (OCT) is able to distinguish from several components of intracoronary structures by different signal patterns. We herein report three cases of various OCT images from ISR lesions in spite of similar angiographic findings. Our OCT findings suggested that ISR lesions that develop after SES implantation might be composed of not uniform but various tissues.
- SourceAvailable from: Jurgen M Ligthart[show abstract] [hide abstract]
ABSTRACT: We describe the clinical and morphological patterns of restenosis after sirolimus-eluting stent (SES) implantation. From 121 patients with coronary angiography obtained >30 days after SES implantation, restenosis (diameter stenosis >50%) was identified in 19 patients and 20 lesions (located at the proximal 5-mm segment in 30% or within the stent in 70%). Residual dissection after the procedure or balloon trauma outside the stent was identified in 83% of the proximal edge lesions. Lesions within the stent were focal, and stent discontinuity was identified in some lesions evaluated by intravascular ultrasound. Sirolimus-eluting stent edge restenosis is frequently associated with local trauma outside the stent. In-stent restenosis occurs as a localized lesion, commonly associated with a discontinuity in stent coverage. Local conditions instead of intrinsic drug-resistance to sirolimus are likely to play a major role in post-SES restenosis.Circulation 07/2003; 108(3):257-60. · 15.20 Impact Factor
- [show abstract] [hide abstract]
ABSTRACT: To understand wound healing after drug-eluting stents (DES) placement in humans, we studied the histology of in-stent restenosis (ISR) tissue obtained by atherectomy from bare metal stents (BMS) and DES in comparison with de novo atherosclerosis. The tissue was retrieved from ISR in ten sirolimus-eluting stents (SES) and nine paclitaxel-eluting stents (PES), six BMS, and nine stenotic de novo atherosclerotic lesions and processed for histology and immunocytochemistry. Patients with ISR in PES showed a significantly higher incidence of unstable angina upon presentation for re-intervention (P = 0.046). De novo tissue tended to be more collagen rich, whereas ISR tissue tended to be more proteoglycan rich. In all groups, cell content consisted almost exclusively of smooth muscle cells. Histology showed that fibrinoid in ISR tissue was present only in DES (P = 0.004), as late as 2 years following DES placement, indicating a persistent incomplete healing response. The amount of fibrinoid, given as a percentage of total tissue in each atherectomy specimen, was greater in PES than in SES (17 vs. 5%, P = 0.026). ISR in DES shows incomplete neointimal healing as late as 2 years after implantation. Patients with ISR in PES presented with more unstable angina and showed more pronounced signs of delayed healing than SES.European Heart Journal 05/2007; 28(8):974-9. · 14.10 Impact Factor
- [show abstract] [hide abstract]
ABSTRACT: Optical coherence tomography (OCT) has recently been proposed as a high-resolution imaging method. Our male patient, who had been treated with a coronary stent, died due to acute leukemia. Coronary artery images using intravascular ultrasound (IVUS) and OCT were obtained postmortem. We also compared the image of neointima formation after stent implantation evaluated by histopathological examination with that evaluated by IVUS and OCT. OCT visualized well-apposed stent struts and neointima formation, which could not be visualized completely by IVUS. OCT may be useful for monitoring structural changes after stent implantation.International Heart Journal 12/2005; 46(6):1133-6. · 1.23 Impact Factor