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A Murine Model of Stent Implantation in the Carotid Artery for the Study of Restenosis
Published on: May 14, 2013
Is there delayed restenosis in patients with coronary artery disease treated with sirolimus-eluting stent?
Jian-Jun Li1, Bo Xu, Yue-Jin Yang
1Department of Cardiology, Fu Wai Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, People's Republic of China. lijnjn@yahoo.com.cn
Insights
Sirolimus-eluting stents show sustained benefit beyond 1 year. However, a higher rate of in-segment restenosis was observed in the late follow-up group, suggesting extended surveillance is needed for coronary artery disease patients.
Area of Science:
- Cardiology
- Interventional Cardiology
- Biomedical Engineering
Background:
- Long-term follow-up of sirolimus-eluting stents (SES) demonstrates sustained clinical benefits.
- Limited data exists on neointimal growth patterns beyond 6-9 months post-SES implantation.
- Delayed restenosis after SES implantation requires further investigation.
Purpose of the Study:
- To evaluate the incidence of delayed restenosis in patients with coronary artery disease treated with SES.
- To assess neointimal growth patterns beyond the initial 6-9 month period.
- To compare early (< or =270 days) versus late (>270 days) follow-up outcomes.
Main Methods:
- A cohort of 333 patients (453 lesions) treated with SES was analyzed.
- Patients were stratified into early (< or =270 days) and late (>270 days) follow-up groups based on quantitative coronary angiography.
- Binary restenosis was defined as >50% lumen diameter stenosis in the target lesion.
Main Results:
- In-stent restenosis rates were similar between early (3.5%) and late (6.0%) groups (P>0.05).
- Late loss and target lesion revascularization showed non-significant trends towards higher rates in the late group.
- In-segment restenosis was significantly higher in the late group (16.7%) compared to the early group (7.9%) (P=0.013).
Conclusions:
- Sirolimus-eluting stent implantation provides sustained clinical benefits beyond one year in real-world practice.
- A higher incidence of late in-segment restenosis was observed, indicating potential for delayed adverse events.
- Prolonged clinical and angiographic surveillance is recommended for patients treated with SES.
Background:
Although long-term follow-up after sirolimus-eluting stent implantation shows a sustained clinical benefit in several randomized and registered trials, little is known about the pattern of neointimal growth beyond the first 6 to 9 months. In this study, we therefore evaluated the possible delayed restenosis in patients with coronary artery disease treated with sirolimus-eluting stent.
Methods:
A total of consecutive 333 patients with 453 lesions were enrolled in this study (among 782 consecutive patients with 1023 lesions). Lesions were subjected to follow-up by quantitative coronary angiography, and patients were divided into two groups according to the time of follow-up by quantitative coronary angiography: early group (< or =270 days, n=270 with 369 lesions) and late group (>270 days, n=63 with 84 lesions). Binary restenosis was defined as stenosis of more than 50% of the lumen diameter in the target lesion.
Results:
Baseline clinical, demographic or angiographic characteristics were well balanced between the two groups. The in-stent restenosis rate was not significant between the early group and the late group (3.5 vs. 6.0%; P>0.05). The late loss and target lesion revascularization appeared higher in late group but there were no significant differences (0.15+/-0.38 mm vs. 0.24+/-0.44 mm; and 4.9 vs. 9.5%, P>0.05, respectively). Similarly, overall thrombosis rate was also same in both groups. In-segment restenosis was, however, higher in late group compared with that in early group (7.9 vs. 16.7%, P=0.013).
Conclusion:
In this unrestricted population, the beneficial effects of sirolimus-eluting stent implantation extend out more than 1 year in real world practice, that has been confirmed by the results of the large randomized clinical trials. The late in-segment restenosis could, however, be found, suggesting that a prolonged clinical and angiographic surveillance in this subset of patients seems to be warranted.
