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Updated: Jul 15, 2026
Imaging In-Stent Restenosis: An Inexpensive, Reliable, and Rapid Preclinical Model
Published on: September 14, 2009
Restenosis after stenting of matched occluded and non-occluded coronary arteries. Should there be a difference?
1Center for Cardiology Othmarschen, Hamburg, Germany.
Insights
Coronary stenting shows similar restenosis rates for occluded and non-occluded lesions. This suggests both lesion types have the same propensity for neointimal hyperplasia after stenting.
Area of Science:
- Cardiovascular Medicine
- Interventional Cardiology
- Angiology
Background:
- Higher restenosis rates historically observed after balloon angioplasty of occluded coronary arteries compared to non-occluded ones.
- Uncertainty regarding whether this disparity persists after coronary stent placement in matched lesions.
Purpose of the Study:
- To investigate if similar restenosis rates are observed after coronary stenting in occluded versus non-occluded lesions when matched for key angiographic factors.
- To compare the late angiographic outcomes, including minimal lumen diameter and restenosis rates, between these two lesion types.
Main Methods:
- Retrospective analysis of 1276 patients undergoing coronary stent placement with 6-month angiographic follow-up.
- Matched pairs of 144 patients with total coronary occlusions and 144 patients with non-occluded lesions.
- Matching criteria included lesion type, stent type, reference vessel diameter, stented segment length, and target vessel.
Main Results:
- Identical minimal lumen diameters were achieved acutely in both occluded and non-occluded groups (2.74 vs. 2.77 mm).
- No significant difference in minimal lumen diameter at 6-month follow-up (1.65 vs. 1.76 mm) or late lumen loss (1.09 vs. 1.01 mm).
- Restenosis rates were comparable: 33% for occluded lesions and 28% for non-occluded lesions (P=0.44).
Conclusions:
- Coronary stenting results in similar 6-month restenosis rates for matched occluded and non-occluded coronary lesions.
- The findings indicate that both lesion types exhibit a similar propensity for neointimal hyperplasia following stenting.
- Longer stented segments (>18 mm) were associated with higher restenosis rates in both occluded and non-occluded lesions.
Aims:
It is not known whether the higher restenosis rates reported after balloon angioplasty of occluded as opposed to non-occluded coronary arteries are still found after placement of coronary stents in lesions matched for factors known to affect late angiographic outcome.
Methods And Results:
In a retrospective analysis of 1276 patients who had undergone coronary stent placement and in whom 6-month angiographic follow-up was available, we identified 144 patients with a total coronary occlusion which matched a non-occluded coronary lesion in another 144 patients. Matching lesion pairs were of the same type (de novo or restenotic), were supplied with the same type of stent, had reference vessel diameters identical within 0.3 mm and stented vessel segment lengths identical within 8 mm, and were located in corresponding target vessels. After stenting, statistically identical minimal lumen diameters had been achieved in both groups (occluded: 2.74+/-0.35 mm, non-occluded: 2. 77+/-0.32 mm, P = 0.45). At follow-up, minimal lumen diameters were not different (occluded: 1.65+/-0.77 mm, non-occluded: 1.76+/-0.76 mm, P = 0.24), reflecting an identical late lumen loss for occlusions (1.09+/-0.76 mm) and non-occluded lesions (1.01+/-0.70 mm, P = 0.38). Because of the significantly larger acute gain, the loss index was significantly lower for occluded vessels (0.40+/-0.27 vs 0. 51+/-0.35, P = 0.003). Corresponding restenosis rates were 33% (occluded) and 28% (non-occluded;P = 0.44). For stented vessel segment lengths >18 mm, restenosis rates were markedly higher (occluded: 42%, non-occluded: 36%) than for stented vessel segment lengths
Conclusions:
In occluded and non-occluded coronary lesions matched for factors known to affect the angiographic outcome, no difference between the respective restenosis rates was observed within 6 months of coronary stenting. Thus, either type of coronary lesion appears to exhibit the same propensity for neointimal hyperplasia.
