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Relative risk analysis of angiographic predictors of restenosis within the coronary Wallstent
B H Strauss1, P W Serruys, I K de Scheerder
1Catheterization Laboratory, Thoraxcenter, Rotterdam, The Netherlands.
Insights
Excessive stent oversizing and using multiple stents per lesion are linked to late restenosis after coronary stenting. Avoiding these practices may reduce the risk of this complication.
Area of Science:
- Cardiovascular Interventions
- Interventional Cardiology
- Medical Device Technology
Background:
- Late angiographic narrowing is a known complication after coronary Wallstent implantation.
- Identifying predictors of restenosis is crucial for improving patient outcomes.
Purpose of the Study:
- To identify angiographic variables that predict restenosis within the stented segment of coronary arteries.
- To inform procedural adjustments to minimize the risk of late restenosis.
Main Methods:
- Retrospective analysis of 214 lesions in 176 patients from the European Wallstent core laboratory.
- Assessment of 16 variables for association with restenosis using relative risk ratios.
Main Results:
- Restenosis incidence was 35% (criterion 1) and 24% (criterion 2).
- Significant predictors of restenosis included use of multiple stents per lesion and oversized stents (diameter > 0.7 mm).
- Bypass grafts and residual diameter stenosis > 20% post-stenting also showed increased risk.
Conclusions:
- Several angiographic variables are significantly associated with late restenosis after coronary stenting.
- Avoiding excessive stent oversizing and multiple stents per lesion may reduce the risk of late restenosis.
Background:
Late angiographic narrowing has been observed following coronary implantation of the Wallstent. To identify the angiographic variables that predict restenosis within the stented segment, a retrospective study of data from the European Wallstent core laboratory was performed.
Methods And Results:
Follow-up angiograms (excluding patients with in-hospital occlusions) were analyzed for 214 lesions in 176 patients (78% restudy rate). The incidence of restenosis within the stented segment was 35% by lesion and 35% by patient for criterion 1 (greater than or equal to 0.72 mm loss in minimal luminal diameter) and 24% by lesion and 24% by patient for criterion 2 (diameter stenosis greater than or equal to 50% at follow-up). The association between 16 variables and restenosis was determined by a relative risk ratio assessment. Variables with significant risk ratios for restenosis with criterion 1 were use of multiple stents/lesion (relative risk, 1.56; 95% confidence interval [CI], 1.08-2.25) and oversized (unconstrained stent diameter exceeding reference diameter greater than 0.7 mm) stents (relative risk, 1.64; 95% CI, 1.10-2.45), and for criterion 2, oversizing by more than 0.70 mm (relative risk, 1.93; 95% CI, 1.13-3.31), bypass grafts (relative risk, 1.62; 95% CI, 0.98-2.66), use of multiple stents/lesion (relative risk, 1.61; 95% CI, 0.97-2.67) and residual diameter stenosis more than 20% post stenting (relative risk, 1.51; 95% CI, 0.91-2.50).
Conclusions:
It is concluded that several angiographic variables are significantly associated with late angiographic narrowing after stenting in the coronary arteries. We suggest that stent operators avoid excessive oversizing in the selection of stent diameter and the use of multiple stents per lesion to lessen the risk of late restenosis.