Sirolimus-eluting stent implantation and β-irradiation for the treatment of in-stent restenotic lesions: Comparison of underlying mechanisms of acute gain and late loss as assessed by volumetric intravascular ultrasound
| Autor: | Johannes Rieber, Uwe Siebert, Karl Theisen, Thomas M. Schiele, Andreas König, Volker Klauss, Marcus Leibig, Isabelle Erhard |
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| Rok vydání: | 2005 |
| Předmět: |
Male
Neointima medicine.medical_specialty Time Factors Intimal hyperplasia Cost effectiveness medicine.medical_treatment Brachytherapy Lumen (anatomy) Coronary Artery Disease Coronary Restenosis Restenosis Angioplasty Intravascular ultrasound medicine Humans Ultrasonography Interventional Aged Drug Implants Sirolimus Hyperplasia medicine.diagnostic_test business.industry Stent Middle Aged medicine.disease Coronary Vessels Beta Particles Treatment Outcome Female Stents Radiology Tunica Intima Cardiology and Cardiovascular Medicine Nuclear medicine business Angioplasty Balloon Follow-Up Studies |
| Zdroj: | American Heart Journal. 150:351-357 |
| ISSN: | 0002-8703 |
| DOI: | 10.1016/j.ahj.2004.09.041 |
| Popis: | Background The aim of the study was to compare the angioplasty mechanisms of drug (sirolimus)-eluting stent (DES) implantation and vascular brachytherapy (VBT) for the treatment of in-stent restenosis (ISR) as assessed by intravascular ultrasound (IVUS). Methods We performed IVUS in 53 patients (28 DES, 25 VBT) before and after angioplasty of ISR and at 6-month follow-up. Cross-sectional areas of the external elastic membrane, the stent, and the lumen were measured. Plaque + media, peristent plaque, and intimal hyperplasia areas were calculated, respectively. Results Clinical and IVUS baseline characteristics did not differ between groups at baseline. After the index procedure, the lumen at the stent site was smaller in the DES group (DES 6.7 ± 2.0 mm 2 vs VBT 7.5 ± 2.2 mm 2 , P = .042). Because of less intimal hyperplasia (DES 0.2 ± 0.5 mm 2 vs VBT 0.7 ± 0.7 mm 2 , P = .043), the lumen dimensions revealed no difference between groups at follow-up (DES 6.5 ± 2.3 mm 2 vs VBT 6.8 ± 2.2 mm 2 , P = .374). At the reference site, the index procedure led to a similar increase of plaque + media (DES 0.9 ± 0.9 mm 2 vs VBT 0.6 ± 1.2 mm 2 , P = .150). At follow-up, the plaque + media was significantly smaller in the DES group (DES 8.0 ± 6.6 mm 2 vs VBT 9.9 ± 7.8 mm 2 , P = .013). Conclusions Drug-eluting stent for the treatment of ISR more effectively inhibits neointima formation when compared with VBT. Yet insufficient stent expansion might be a reason for device failure and should be avoided. At the reference site, lumen loss by an increased plaque burden, as has been well recognized following VBT, is not present with DES. |
| Databáze: | OpenAIRE |
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