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A Murine Model of Stent Implantation in the Carotid Artery for the Study of Restenosis
Published on: May 14, 2013
Factors Associated with Coronary In-Stent Restenosis after Drug-Eluting Stent Implantation in Patients on Chronic
Hiroshi Sugita1, Masayuki Motohiro1, Syun Morishita1
1Cardiovascular Division, Department of Medicine II, Kansai Medical University, Hirakata, Japan.
Insights
In patients on chronic hemodialysis, drug-eluting stents (DESs) showed a 22.4% in-stent restenosis (ISR) rate. Smaller minimal lumen diameter, longer lesion length, and rotational atherectomy use independently predicted ISR.
Area of Science:
- Cardiovascular Medicine
- Interventional Cardiology
- Nephrology
Background:
- Drug-eluting stents (DESs) are increasingly used in patients undergoing chronic hemodialysis (HD).
- The effectiveness of DESs in reducing in-stent restenosis (ISR) in this specific population remains uncertain.
- Understanding ISR predictors is crucial for optimizing treatment strategies in HD patients.
Purpose of the Study:
- To investigate the incidence of ISR after DES implantation in patients on chronic HD.
- To identify independent predictors of ISR in this patient cohort.
- To compare ISR rates between first- and second-generation DESs.
Main Methods:
- Retrospective analysis of 194 patients (331 lesions) on HD who underwent follow-up angiography post-DES implantation.
- Assessment of ISR incidence and angiographic characteristics.
- Multivariate analysis to determine independent predictors of ISR.
Main Results:
- ISR was observed in 22.4% of lesions.
- Independent predictors of ISR included smaller minimal lumen diameter (MLD) before implantation, longer lesion length (LL), and use of rotational atherectomy.
- No significant difference in ISR rates was found between first-generation (25.8%) and second-generation DESs (20.4%).
Conclusions:
- A small MLD, long LL, and rotational atherectomy use are significant predictors of ISR in HD patients treated with DESs.
- The incidence of ISR was not significantly different between first- and second-generation DESs.
- These findings highlight the need for careful patient selection and procedural technique optimization.
Aims:
Recently, drug-eluting stents (DESs) have been widely adopted for patients on chronic hemodialysis (HD). However, whether DES implantation is associated with a reduced rate of in-stent restenosis (ISR) is unclear. We investigated the incidence of ISR and its predictors in patients on HD after DES implantation.
Methods And Results:
We analyzed 194 consecutive patients (331 lesions) on HD who underwent follow-up angiography after DES implantation. ISR was observed in 74 lesions (22.4%). Angiographically, the relative incidence of AHA/ACC type C lesion was increased (47 vs. 32%; p = 0.043), the minimal lumen diameter (MLD) before DES implantation was smaller (0.82 ± 0.49 vs. 0.97 ± 0.45 mm; p < 0.01), and the lesion length (LL) was increased (30.2 ± 16.1 vs. 24.4 ± 12.1 mm; p = 0.023) in lesions with ISR compared to those without ISR. The rate of rotational atherectomy use was also increased in lesions with ISR compared to those without ISR (50% vs. 25%; p < 0.01). In a multivariate analysis, the MLD before DES implantation (odds ratio [OR] = 0.50, 95% confidence interval [CI] 0.27-0.91, p = 0.024), LL (OR = 1.02, 95% CI 1.00-1.04, p = 0.030) and the use of rotational atherectomy (OR = 2.71, 95% CI 1.55-4.72, p < 0.01) were independent predictors of ISR. The incidence of ISR was similar between lesions treated with the first-generation (25.8%) and the second-generation DESs (20.4%).
Conclusions:
ISR was observed in 74 lesions (22.4%). A small MLD, long LL, and the use of rotational atherectomy were independent predictors of ISR after DES implantation in patients on HD. There was no significant difference in the ISR rate between the first- and the second-generation DESs.
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