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

被引:18
作者
Kay, IP
Wardeh, AJ
Kozuma, K
Sianos, G
Regar, E
Knook, M
van der Giessen, WJ
Thury, A
Ligthart, JMR
Coen, VMA
Levendag, PC
Serruys, PW
机构
[1] Acad Ziekenhuis Rotterdam, Thoraxctr, NL-3000 DR Rotterdam, Netherlands
[2] Dr Daniel den Hoed Canc Ctr, NL-3008 AE Rotterdam, Netherlands
关键词
stents; remodelling; radioisotopes; angioplasty; ultrasonics;
D O I
10.1053/euhj.2000.2542
中图分类号
R5 [内科学];
学科分类号
1002 ; 100201 ;
摘要
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 post-stent 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' wets 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: A neointimal hyperplasia=3.72 mm(3) (8.6%); in-stent at the edges of radiation proximally and distally A neointimal hyperplasia was 7.9 mm(3) (19.0%) and 11.4 mm(3) (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.
引用
收藏
页码:1311 / 1317
页数:7
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