冠心病患者支架置入术后再狭窄原因的临床研究

目的通过对经皮冠状动脉介入术后复查冠状动脉造影患者的回顾性分析,研究引起支架内再狭窄(ISR)的可能原因。方法入选我院2008—2011年所有复查造影的冠心病支架治疗患者210例,平均年龄(68.9±7.8)岁;男125例,女85例,将其分成支架内再狭窄组和无再狭窄组,分析两组间可能导致支架内再狭窄的因素。结果 210例患者共置入352枚支架,其中有37枚支架发生再狭窄(支架内再狭窄定义为随访时造影提示支架内管腔内径损失≥50%)。分析两组临床资料特征及支架长度、直径,是否为药物涂层支架等因素;支架内再狭窄组及无再狭窄组在脂蛋白(a)、支架长度、和药物/非药物支架方面有显著差异(P<0.05)。Cox比例风险回归模型显示仅支架长度(P=0.007)、直径(P=0.022)和药物/非药物支架(P=0.036)为冠心病介入患者发生ISR的预测因子。结论冠状动脉支架置入后发生再狭窄的主要原因为支架长度、直径及是否为药物支架。     

冠脉支架植入术后支架内再狭窄的危险因素分析

目的:探讨冠状动脉支架植人术后支架内再狭窄发生的危险因素。方法:对2006年1月1日至2006年12月31日在我院行冠状动脉支架植入术后行冠状动脉造影随访的121例资料进行了回顾性分析。统计学上采用logis-tic多因素逐步回归分析。结果:多因素logistic回归分析显示再狭窄与患者是否有糖尿病,是否吸烟以及第二次冠脉介入治疗前LDL-C水平成显著正相关,其相对危险度(RR)分别为11.55、5.48和12.60;而与支架是否为药物涂层成负相关,RR为0.01。结论:糖尿病患者为支架术后再狭窄的的高危人群,药物支架可减少再狭窄的发生。对于支架植入术后的患者,戒烟以及控制LDL-C的水平是减少支架内再狭窄的关键因素。     

Lp-PLA2、PTX3对冠心病患者PCI术后支架内再狭窄的预测价值

目的 探讨脂蛋白相关性磷脂酶A2(Lp-PLA2)、正五聚蛋白-3(PTX3)对冠状动脉粥样硬化性心脏病（CHD）患者经皮冠状动脉介入（PCI）术后支架内再狭窄（ISR）的预测价值。方法 选取因冠状动脉严重狭窄行PCI治疗的CHD患者379例。根据术后6个月复查是否发生ISR,分为ISR组（n=53)、非ISR组(n=326)。收集两组一般临床资料,监测两组术后1 d的Lp-PLA2和PTX3水平。采用Logistic逐步回归分析ISR发生的危险因素。术后6个月复查外弹力膜横截面积（EEM-CSA）、斑块面积（PLA）、最小管腔面积（MLA）,内膜面积（IPA）及Gensini积分。分析Lp-PLA2和PTX3与Gensini积分、EEM-CSA、MLA、PLA、IPA的相关性。采用ROC曲线评估Lp-PLA2和PTX3预测ISR的最佳截断值与AUC。结果 (1)ISR组STEMI(P<0.05)、吸烟史（P<0.01）、糖尿病（P<0.01）、LDL-C(P<0.05)、支架串联（P<0.05）、应用分叉术式（P<0.01）、支架置入时长（P<...     

外周血Toll样受体4及TNF-α与冠状动脉支架置入术后再狭窄的关系

目的:支架术后再狭窄(in-stent restenosis,ISR)是影响冠状动脉介入疗效的主要问题,本研究探讨外周血Toll样受体4(toll like receptor4,TLR4)及TNF-α与冠状动脉支架置入术后再狭窄的相关性。方法:入选135例稳定型心绞痛患者,冠状动脉造影示单支血管病变,并成功置入支架,术后6~12个月复查冠状动脉造影,将患者分为支架术后再狭窄组和无再狭窄组,采用流式细胞技术测定支架置入术前及术后5~7d外周血单核细胞TLR4的表达量,同时用酶联免疫吸附试验法(ELISA)检测血清中TNF-α的浓度。结果:复查冠状动脉造影发现14例患者发生支架内再狭窄,占10.4%,无再狭窄组121例,占89.6%。组间比较:术前TLR4及TNF-α的表达水平在两组间差异无统计学意义。分别为:TLR4[(144.20±52.99)vs.(117.40±61.9),P0.05],TNF-α[(34.32±11.97)vs.(27.47±14.47)ng/L;P0.05];术后5~7d两组患者TLR4与TNF-α表达均升高,且再狭窄组升高更明显:TLR4[(182.20±61.59)vs.(125.10±61.9),P0.01],TNF-α(52.62±19.04)vs.(32.63±13.71)ng/L,P0.01)。再狭窄组术后TLR4和TNF-α均升高,与支架置入术前相比差异有统计学意义;术后血清中TNF-α的浓度与外周血单核细胞中TLR4表达的平均荧光强度呈正相关。结论:冠状动脉支架置入术后外周血TLR4及TNF-α的表达均升高,且再狭窄组升高更明显,与无再狭窄组比较,差异有统计学意义。推测TLR4及TNF-α介导的炎症反应与支架术后再狭窄相关。     

老年冠心病患者支架内再狭窄危险因素分析

目的 探讨老年冠心病患者冠脉支架术后支架内再狭窄(ISR)的危险因素.方法 选取2016年1月-2019年12月在复旦大学附属华东医院心内科行经皮冠状动脉支架植入术,并于术后12个月常规复查冠脉造影的老年冠心病患者共208例作为研究对象,根据是否发生ISR,他们被分为ISR组(24例)和非ISR组(184例),比较2组...     

血浆脑钠尿肽水平与冠状动脉支架植入术后再狭窄有关

目的:探讨冠心病患者血浆脑钠尿肽(BNP)水平与冠状动脉支架内再狭窄的关系。方法:选择317例接受冠状动脉支架植入术(PCI)以及术后1年内再次接受冠状动脉造影(CAG)检查的患者,分为再狭窄和无再狭窄组,分别在PCI术前、出院前和复查CAG前测定血浆BNP水平,两组患者分别比较相应的BNP水平。结果:再狭窄组PCI术前、出院前及复查CAG前的BNP水平与无再狭窄组分别进行比较,差异有统计学意义(P0.05),多因素logistic回归分析结果,血浆BNP水平是预测再狭窄的独立危险因子(均P0.01)。结论:血浆BNP水平与PCI术后再狭窄密切相关,有可能作为再狭窄的有用预测指标。     

骨保护素与冠心病合并糖尿病患者冠状动脉支架内再狭窄的关系

目的探讨血清骨保护素(OPG)与冠心病合并糖尿病患者冠状动脉介入术后支架内再狭窄(ISR)的关系。方法在行经皮冠状动脉介入治疗并于约1年后行冠状动脉造影复查的1 652例糖尿病患者中,135例为ISR患者(ISR组),从其余患者中随机选取85例无ISR的冠心病合并糖尿病患者作为对照(无ISR组)。检测血清OPG水平及生物化学指标,并收集患者的临床资料。通过多变量Logistic回归分析发生ISR的独立危险因素。结果 ISR组血清OPG水平显著高于无ISR组(P<0.001)。与无ISR组相比,ISR组患者的吸烟发生率更高,血清肌酐、总胆固醇、高敏C反应蛋白、低密度脂蛋白胆固醇水平更高,冠状动脉病变更严重,累及的血管更多,肾小球滤过率更低,使用降糖药物治疗患者更少,支架直径更小(P均<0.05)。将血清OPG水平按三分位数分组,在校正了可能的混杂因素后,多变量Logistic回归分析显示血清OPG高水平组发生ISR的风险是低水平组的5.349倍(OR=5.349,95%CI为2.049～13.967,P=0.001),中水平组发生ISR的风险是低水平组的2.711倍(OR=2...     

基质金属蛋白酶-9和内皮素-1评价冠状动脉内支架术后再狭窄的意义

目的探讨动态检测基质金属蛋白酶（MMP）-9、内皮素（ET）-1在经皮冠脉介人术（PCI）后再狭窄的意义。方法对30例经皮冠脉介人术后患者进行造影及光学相干断层成像（OCT）检查随访,造影证实再狭窄5例,共7处病变;无再狭窄25例,共34处病变。测量并比较两组内膜组织覆盖厚度、最狭窄处血管管腔面积、最狭窄处支架面积等,计算支架的最大内膜组织覆盖面积及支架的内膜组织覆盖面积百分比。术前及随访时均行MMP-9及ET-1检测,比较两组PCI前后MMP-9和ET-1的变化。结果与无再狭窄组比较,再狭窄组有更大的内膜组织覆盖厚度、内膜组织覆盖面积及更少的最小管腔面积。术前再狭窄组和非再狭窄组的MMP一9和ET—l浓度均无明显差异;术后再狭窄组的MMP一9、ET一1浓度明显高于非再狭窄组（P〈O．05）;术后再狭窄组MMP-9、ET-1浓度较术前明显升高（P〈0．05）;非再狭窄组术后MMP-9、ET-1浓度较术前均无明显变化。多因素Logistic回归分析显示,冠状动脉支架术后支架内再狭窄可能与MMP-9水平（P〈0．01,OR=1．84,95％CI：1．38-2．43）和ET-1水平（P〈0．0l,OR=1．37,95％CI：1．19~2．57）呈正相关。结论PCI后支架内再狭窄患者MMP-9和ET-1水平较术前升高。MMP-9及ET-1可作为预测冠脉再狭窄的参考指标。     

氧化低密度脂蛋白、高敏C反应蛋白与冠状动脉支架置入术后再狭窄的关系

目的:探讨氧化低密度脂蛋白(ox-LDL)、高敏C反应蛋白(hs-CRP)与经皮冠状动脉介入治疗(PCI)术后支架内再狭窄的相关性。方法:45例患者PCI术后6~12个月内接受冠状动脉造影复查,其中18例有再狭窄作为再狭窄组,27例无再狭窄作为对照组。2组术后均接受阿司匹林、波立维、他汀类等药物治疗。取2组患者PCI术前、后冠状动脉造影复查时血浆标本,采用酶联免疫吸附法(ELISA)检测血浆ox-LDL水平,超敏免疫比浊法检测血浆hs-CRP水平,酶法测定血脂水平。结果:①再狭窄组PCI术后ox-LDL、hs-CRP水平较术前均明显升高[(1.32±0.35)∶(0.53±0.17)mg/L、(4.82±1.44)∶(3.50±1.18)mg/L],均P0.01;对照组PCI后ox-LDL、hs-CRP水平较术前明显下降[(0.32±0.13)∶(0.55±0.13)mg/L、(2.28±0.71)∶(3.37±1.25)mg/L],均P0.05。②再狭窄组和对照组PCI术前ox-LDL、hs-CRP水平差异无统计学意义,再狭窄组PCI术后ox-LDL、hs-CRP水平显著高于对照组(均P0.01)。③再狭窄组和对照组术后TC、TG、LDL-C水平均较术前明显下降(P0.05),但2组间PCI术前和术后比较均差异无统计学意义(P0.05)。④再狭窄组和对照组术前、术后ox-LDL和hs-CRP水平均呈正相关。结论:PCI术后再狭窄患者血浆ox-LDL及CRP水平明显升高,二者可作为PCI术后再狭窄的预测指标。     

持续炎症状态对冠状动脉支架内再狭窄的影响和预测分析

目的探讨PCI前后持续炎症状态对PCI后支架内再狭窄的影响和预测作用。方法选择成功行支架置入术并于3个月后至1年内复查冠状动脉造影的患者431例,分为支架内再狭窄组(再狭窄组)124例和无支架内再狭窄组(无再狭窄组)307例。患者于PCI前及复查冠状动脉造影时均检测C反应蛋白(CRP)、高敏CRP(hs-CRP)。结果与无再狭窄组比较,再狭窄组患者PCI前CRP和hs-CRP以及PCI后CRP均明显升高,差异有统计学意义(P0.05,P0.01)。将PCI前hs-CRP分为2 mg/L和≤2 mg/L2个等级,hs-CRP增高的患者支架内再狭窄的发生率明显升高(χ~2=5.03,P0.05)。logistic回归分析显示,hs-CRP高的患者发生支架内再狭窄的风险明显增加(OR=1.840,95% CI:1.076～3.157,P0.05)。结论 PCI前后持续的炎症状态是发生支架内再狭窄的危险因素和预测指标,应积极加强抗炎以改善PCI后患者的临床预后。     

The value of serum levels of aldosterone in predicting in-stent restenosis after coronary stent implantation

In recent years,Percutaneous coronary intervention(PCI) as an effective treatment for coronary heart disease has been widely carried out in China.However,people is still confronted with the problem that the incidence of in-stent restenosis (ISR) after PCI.Some risk factors of coronary heart disease have been obviously known,but the in-dependent predictor factors for the ISR has not been clear.Clarifying risk factors for ISR to establish interfering meas-ures may be a new direction for PCI treatment in the future.At present,it has been reported that aldosterone (ALD) may be involved in ISR.In order to further investigate the relationship between the serum ALD levels and ISR,our re-search was to determine the ALD and other serum markers to explore the impact factors of ISR.Methods We meas-ured serum ALD,high sensitivity C-reactive protein (hs-CRP) ,adiponectin (ADP) and other indicators in 258 pa-tients with coronary stenting,and made routine follow-up for 6-9 months to perform coronary angiography.According to the results of coronary angiography,all patients were divided into restenosis group and non-restenosis group.We an-alyzed the relationship between ALD,other indicators and ISR to explore whether serum ALD was an independent risk factor ISR.Results Serum ALD levels were significantly higher in restenosis group than non-restenosis group.Logis-tic regression analysis showed that diabetes,ALD,hs-CRP and complex lesions were also independent risk factors for ISR (P 0.05) ,while the ADP was as a protective factor for ISR (P 0.05) .Conclusions ALD is one of inde-pendent risk factors for ISR after undergoing coronary stent implantation in patients.It has the possibility of becoming one new method in this medical field.     

凝集素样氧化型低密度脂蛋白受体水平对冠状动脉支架置入术后再狭窄的预测价值

目的探讨冠状动脉粥样硬化性心脏病(冠心病)患者冠状动脉支架置入术后血清凝集素样氧化型低密度脂蛋白受体-1(Lox-1)变化趋势及与支架内再狭窄(ISR)的关系。方法连续入选经皮冠状动脉介入治疗并置入冠状动脉支架的冠心病患者128例。分别于术前和术后24h、1周、2周、1月、3月、6月时采集外周静脉血,测定血清Lox-1水平。所有患者术后6月常规复查冠状动脉造影,以支架内径狭窄≥50%为再狭窄,分为再狭窄组(n=24)和无再狭窄组(n=104),并分析两组患者血清Lox-1水平变化趋势及差别。结果术后24h两组患者血清Lox-1水平较术前明显增加,有统计学差异(P0.05);冠状动脉无再狭窄组患者术后1周血清Lox-1水平有下降趋势,2周时恢复至术前水平,术后1个月、3个月、6个月血清Lox-1水平与术前比较无统计学差异(P0.05)。冠状动脉再狭窄组患者血清Lox-1水平术后两周、术后1个月、3个月、6个月时血清Lox-1水平呈持续性升高,与无再狭窄组相比,差异有统计学意义(P0.05)。结论冠状动脉支架置入患者血清Lox-1水平在两周时基本恢复至术前水平,未恢复至术前水平且持续升高者发生支架内再狭窄危险性高。     

Value of M2BP in predicting in‐stent restenosis in patients after coronary drug‐eluting stent implantation

ObjectiveWe evaluated the association between plasma levels of mac‐2 binding protein (M2BP) with the risk of in‐stent restenosis (ISR) after percutaneous coronary intervention (PCI).MethodsPlasma M2BP levels were compared between 258 patients who experienced ISR at 12‐months post‐PCI and 258 patients, matched for age and sex, without angiographic evidence of ISR.ResultsThe plasma M2BP level was significantly higher in the ISR than in the non‐ISR group. On multivariate analysis, adjusted for potential clinical, biochemical, and angiography characteristics, M2BP remained as an independent significant predictor of ISR.ConclusionsM2BP may be an important predictive biomarker of ISR and may be useful in identifying at‐risk patients.     

冠状动脉支架内再狭窄的治疗进展

经皮冠状动脉介入（percutaneous coronary intervention, PCI）治疗已成为一种治疗冠状动脉狭窄性病变的有效手段,不论是药物涂层支架的广泛应用,还是以药物球囊为标志的无植入年代,PCI术后再狭窄是影响其远期疗效与预后的重要因素。而支架内再狭窄（in-stent restenosis, ISR）依然是PCI术后再狭窄的主要群体, ISR可能导致主要不良心血管事件的复发,包括心绞痛、急性心肌梗死,甚至心源性猝死。因此,再次关注ISR的治疗问题依然具有重要的临床意义。     

残余胆固醇与LDL-C达标的冠心病患者PCI术后支架内再狭窄的相关性

目的：探讨低密度脂蛋白胆固醇（LDL-C）达标的冠心病PCI术后患者远期支架内再狭窄（ISR）的危险因素及其与残余胆固醇（RC）的相关性。方法：采用病例对照研究方法，选择2015年01月至2022年10月于宜兴市人民医院心内科住院的冠心病患者共239例，所有患者均为支架植入术后复查冠状动脉造影；入院次日空腹检测血常规、血生化等指标。根据住院期间冠脉造影结果分为ISR组和non-ISR组。采用IBM SPSS Statistics 16.0软件进行分析，根据不同数据类型分别使用t检验，Mann-whitney 检验或Kruskal-Wallis秩和检验；相关分析采用Spearman相关分析法；绘制ROC曲线确定RC的最佳截断值；采用多因素二分类Logistic回归分析ISR的相关危险因素。结果：两组间一般资料比较显示，non-ISR与ISR组在性别、高血压、支架植入时间、TG、HDL-C、LDL-C、Lp-a均无明显差异，无统计学意义（p＞0.01），而年龄、糖尿病、吸烟、TC、RC、多支病变、支架个数、支架总长度在两组间有统计学意义（p＜0.05）。计算RC四分位间距，根据四分位间距分为四组（Q1-Q4），四组间ISR的发病率分别为20%、14.8%、22%、40.7%，有统计学意义（p＜0.05）；进一步采用Spearman相关分析发现，RC与ISR存在相关，相关系数为0.179，p＜0.05；受试者工作曲线（ROC）分析表明，RC的ROC为0.636（95%CI 0.572~0.697，p＜0.05）。通过计算约登指数，得出RC的最佳阶段点为0.47mmol/L，对应的灵敏度和特异度分别为51.72%，75.14%；二分类logistic回归分析：年龄、吸烟、多支病变、支架总长度以及RC＞0.47mmol/L是ISR的危险因素（p＜0.05），其中RC＞0.47mmol/L的患者发生ISR的风险是≤0.47mmol/L的患者的3.416倍（p=0.003）。结论：在LDL-C达标的PCI术后的冠心病患者中，RC与ISR存在相关性，且RC是PCI术后发生ISR的独立危险因素。     

超敏C反应蛋白和脂蛋白a测定在冠状动脉植入药物洗脱支架后发生支架内再狭窄的意义

目的:探讨超敏C反应蛋白(hs-CRP)和脂蛋白a(LP(a))测定在冠状动脉植入药物洗脱支架后发生支架内再狭窄的意义。方法:在上海中山医院复查冠脉造影的486例患者资料进行了回顾性分析。结果:发生再狭窄的患者第二次冠脉造影前超敏CRP水平(3.1±3.7mg/L比1.0±1.4mg/L,P<0.01)和Lp(a)水平(271±267.5mol/L比167.7±122.3mol/L,P<0.01)均较无再狭窄组增高;多因素Logistic逐步回归分析显示药物洗脱支架术后支架内再狭窄与超敏CRP水平(P=0.002,OR=1.655,95%CI:1.195～2.291)、Lp(a)水平(P=0.012,OR=1.004,95%CI:1.001～1.007)成正相关。结论:对于药物洗脱支架植入术后的患者,控制超敏CRP、Lp(a)水平是减少支架内再狭窄的重要因素。     

血管内皮生长因子、支架直径和支架长度对支架内再狭窄的联合预测价值

目的 探讨血管内皮生长因子（vascular endothelial growth factor,VEGF）、支架直径和支架长度对冠状动脉药物洗脱支架(drug-eluting stent, DES)置入术后支架内再狭窄（in-stent restenosis,ISR）患者的联合预测价值。 方法 收集2014年6月至2016年8月在承德市中心医院心内科行DES置入的不稳定型心绞痛患者332（男178,女154）例。根据术后1年复查冠脉造影结果将其分为ISR组（n=41）和非ISR组（n=291）,比较两组的一般临床资料及冠脉支架手术资料。采用酶联免疫吸附试验（ELISA）测定冠脉支架置入术前、术后6个月、术后12个月患者血清VEGF的水平,比较两组间VEGF的表达差异。 结果 ISR组及非ISR组患者术前VEGF水平无明显差异[（499±39）ng/L vs（503±35）ng/L];术后两个时间点ISR组VEGF水平显著低于非ISR组[（377±33）ng/L vs（462±56）ng/L;（184±34）ng/L vs（361±45）ng/L],差异均有统计学意义（均P<0.01）。Logistic回归分析表明:术后VEGF水平（OR=0.95,95%CI:0.92-0.97;P<0.01）是ISR的保护性因素;2型糖尿病（OR=14.81,95%CI:1.96-111.81;P<0.01）、术后吸烟（OR=32.74,95%CI:4.74-226.03;P<0.01）与ISR密切相关,是ISR的独立危险因素;支架长度（OR=1.26,95%CI:1.09-1.46;P<0.01）与ISR成正相关;支架直径（OR=0.03,95%CI:0.00-0.23;P<0.01）与ISR呈反相关。经绘制ROC曲线及支架直径、支架长度的联合指标的ROC曲线显示VEGF对ISR的预测价值较好,而VEGF联合支架长度及直径指标优于单独指标。 结论 术后VEGF水平与ISR密切相关,是ISR的一项独立预测因素,可作为临床评估ISR的一项指标,而VEGF联合支架直径和支架长度指标对预测ISR效能最优。     

HDL对支架生物相容性的影响以及PCI术后HDL输注治疗的潜在价值

尽管介入技术与支架设计不断进步,但是支架生物相容性方面的问题仍然存在,包括支架内新生动脉粥样硬化和再内皮化延迟,这些问题会导致支架内再狭窄(ISR)和支架内血栓形成(ST).高密度脂蛋白(HDL)是一种重要的抗动脉粥样硬化因子,对动脉粥样硬化性心血管疾病(ASCVD)的患者具有保护作用.它能够维护血管内皮正常功能、保护...     

Increased incidence of coronary in-stent restenosis in type 2 diabetic patients is related to elevated serum malondialdehyde-modified low-density lipoprotein.

BACKGROUND: Type 2 diabetes mellitus (T2DM) has been reported as a major risk factor for in-stent restenosis (ISR) after intracoronary stenting, although the details of the mechanisms remain undefined. The aim of present study was to investigate the diabetes-related risk factor for ISR. METHODS AND RESULTS: A total of 131 patients who were implanted with bare metal stent(s) were enrolled in this study. Based on follow-up coronary angiography at 6 months after stenting, the patients were classified according to the presence or absence of ISR. Various coronary risk factors, including serum malondialdehyde-modified low-density lipoprotein (MDA-LDL) levels, were investigated at follow-up angiogram to relate to ISR in patients with or without T2DM. The increased incidence of ISR was observed in diabetic patients, which was significantly related to the increased serum MDA-LDL concentrations. The serum MDA-LDL concentration was positively correlated to glycohemoglobin levels in diabetic patients. In addition, MDA-LDL concentration was not altered after the treatment of ISR. CONCLUSIONS: The elevated serum MDA-LDL level is considered to be a potent risk factor for ISR in diabetic patients. MDA-LDL, which might be a consequence of metabolic abnormalities caused by diabetes, may act as a growth factor for neointimal tissues inside the implanted stent.     

Distribution and Magnitude of Shear Stress after Coronary Bifurcation Lesions Stenting with the Classical Crush Technique: A New Predictor for In‐Stent Restenosis

Background: Wall shear stress (SS) plays an important role in the initiation and proliferation of coronary atherosclerosis, especially for bifurcations. Stenting in the coronary artery will cause many different changes in velocity, flow, cross‐sectional area, and especially the wall SS. However, it is still unknown how much wall SS distribution varies with stenting in coronary bifurcation. Objective: The purpose of this study was to investigate the magnitude and distribution of wall SS after the classical crush stenting for bifurcation lesions. Methods: Eleven patients with true coronary bifurcation stenting by the classical crush technique were included. We studied the difference of wall SS between restenosis and nonrestenosis groups in these patients. The differences in SS between preprocedure and postprocedure, as well as between immediately postprocedure and after an 8‐month follow‐up, were also analyzed. Diameter stenosis or minimal lumen diameter were measured by quantitative coronary analysis. The commercial CD STAR‐CCM+ was used to calculate the SS. Results: At baseline, the SS in all the segments of all patients was high. The baseline SS of the restenosis group was 50% lower than the nonrestenosis group. Immediately after percutaneous coronary intervention (PCI), the SS in both areas decreased; however, the SS of the nonrestenosis group decreased to its lowest level possible while the SS of the restenosis group decreased moderately. Eight months later, the SS of all the segments of the nonrestenosis group remained persistently low at the same level of right after PCI. In contrary, the SS in the restenosis group returned to near its baseline level. Conclusion: From our study, after a 2‐stent crush technique using drug‐eluting stents (DES), the degree of SS reduction appears to predict in‐stent restenosis (ISR). A SS decrease to its lowest level and remaining homogenously low is a prime condition to prevent ISR. A baseline low SS, which decreases minimally after PCI and recovers to around its baseline level, appears to be the setting for restenosis. These conditions can be evaluated as predictors of lesions that may need surveillance angiography and proper IVUS evaluation to prevent future in‐stent restenosis. (J Interven Cardiol 2010;23:330–340)