The pattern of restenosis and vascular remodelling after cold-end radioactive stent implantation

I. P. Kay, A. J. Wardeh, K. Kozuma, G. Sianos, E. Regar, M. Knook, W. J. Van Der Giessen, A. Thury, J. M.R. Ligthart, V. M.A. Coen, P. C. Levendag, P. W. Serruys

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Abstract

Background: Edge restenosis is a major problem after radioactive stenting. The cold-end stent has a radioactive mid-segment (15.9 mm) and non-radioactive proximal and distal 5.7 mm segments. Conceptually this may negate the impact of negative vascular remodelling at the edge of the radiation. Method and Results: ECG-gated intravascular ultrasound with three-dimensional reconstruction was performed poststent implantation and at the 6-month follow-up to assess restenosis within the margins of the stent and at the stent edges in 16 patients. Angiographic restenosis was witnessed in four patients, all in the proximal in-stent position. By intravascular ultrasound in-stent neointimal hyperplasia, with a >50% stented cross-sectional area, was seen in eight patients. This was witnessed proximally (n=2), distally (n=2) and in both segments (n=4). Echolucent tissue, dubbed the 'black hole' was seen as a significant component of neointimal hyperplasia in six out of the eight cases of restenosis. Neointimal hyperplasia was inhibited in the area of radiation: Δ neointimal hyperplasia=3.72 mm3 (8.6%); in-stent at the edges of radiation proximally and distally Δ neointimal hyperplasia was 7.9 mm3 (19.0%) and 11.4 mm3 (25.6%), respectively (P=0.017). At the stent edges there was no significant change in lumen volume. Conclusions: Cold-end stenting results in increased neointimal hyperplasia in in-stent non-radioactive segments.

Original languageEnglish
Pages (from-to)1311-1317
Number of pages7
JournalEuropean heart journal
Volume22
Issue number15
DOIs
Publication statusPublished - Aug 22 2001

Keywords

  • Angioplasty
  • Radioisotopes
  • Remodelling
  • Stents
  • Ultrasonics

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine

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    Kay, I. P., Wardeh, A. J., Kozuma, K., Sianos, G., Regar, E., Knook, M., Van Der Giessen, W. J., Thury, A., Ligthart, J. M. R., Coen, V. M. A., Levendag, P. C., & Serruys, P. W. (2001). The pattern of restenosis and vascular remodelling after cold-end radioactive stent implantation. European heart journal, 22(15), 1311-1317. https://doi.org/10.1053/euhj.2000.2542