BACKGROUND: We describe the clinical and morphological patterns of restenosis after sirolimus-eluting stent (SES) implantation. METHODS AND RESULTS: From 121 patients with coronary angiography obtained >30 days after SES implantation, restenosis (diameter stenosis >50%) was identified in 19 patients and 20 lesions (located at the proximal 5-mm segment in 30% or within the stent in 70%). Residual dissection after the procedure or balloon trauma outside the stent was identified in 83% of the proximal edge lesions. Lesions within the stent were focal, and stent discontinuity was identified in some lesions evaluated by intravascular ultrasound. CONCLUSIONS: Sirolimus-eluting stent edge restenosis is frequently associated with local trauma outside the stent. In-stent restenosis occurs as a localized lesion, commonly associated with a discontinuity in stent coverage. Local conditions instead of intrinsic drug-resistance to sirolimus are likely to play a major role in post-SES restenosis.

Adult, Aged, Angioplasty, Transluminal, Percutaneous Coronary, Blood Vessel Prosthesis Implantation/*adverse effects, Coronary Angiography, Coronary Restenosis/*diagnosis/*etiology, Drug Implants/adverse effects, Female, Follow-Up Studies, Humans, Immunosuppressive Agents/adverse effects, Male, Middle Aged, Postoperative Complications/diagnosis/etiology, Registries, Sirolimus/*adverse effects, Stents/*adverse effects, Treatment Outcome, Ultrasonography, Interventional,
Circulation (Baltimore)
Epub 2003 Jul 14
Erasmus MC: University Medical Center Rotterdam

Lemos Neto, P.A, Saia, F, Ligthart, J.M.R, Arampatzis, C.A, Sianos, G, Tanabe, K, … Serruys, P.W.J.C. (2003). Coronary restenosis after sirolimus-eluting stent implantation: morphological description and mechanistic analysis from a consecutive series of cases. Circulation (Baltimore), 108(3), 257–260. doi:10.1161/01.CIR.0000083366.33686.11