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Late target lesion revascularization after implantation of sirolimus‐eluting stent
Authors:Myeong‐Ki Hong MD  PhD  Gary S Mintz MD  Cheol Whan Lee MD  PhD  Duk‐Woo Park MD  Seung‐Whan Lee MD  PhD  Young‐Hak Kim MD  PhD  In‐Hyun Jung MD  Sang‐Hyun Kim MD  Sang‐Sig Cheong MD  PhD  Jae‐Joong Kim MD  PhD  Seong‐Wook Park MD  PhD  Seung‐Jung Park MD  PhD
Institution:1. Department of Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea;2. Cardiovascular Research Foundation, New York, New York;3. Department of Medicine, Asan Medical Center, University of Ulsan College of Medicine, GangNeung, Korea
Abstract:Objectives : We evaluated the incidence, clinical presentation, and angiographic in‐stent restenosis (ISR) pattern of late target lesion revascularization (TLR) after sirolimus‐eluting stent (SES) implantation. Background : Late TLR is an unusual finding beyond 6–9 months after bare‐metal stent implantation. However, late TLR after SES implantation has not been sufficiently evaluated. Methods : The study population consisted of 804 patients with 1,020 native lesions that were patent at 6‐month follow‐up angiogram after SES implantation. Results : Late TLR was performed in 18 patients with 18 lesions (1.8%) at 24.1 ± 2.6 months (range; 18–30 months) after SES implantation. Clinical presentation of late TLR patients was silent ischemia in eight patients and recurrent angina in 10 patients, but none had an acute coronary syndrome. Angiographic ISR pattern of late TLR lesions were focal ISR in 12 lesions (67%) and diffuse ISR in six lesions (33%). Serial quantitative coronary angiographic analysis of these lesions showed a minimal lumen diameter of 2.6 ± 0.5 mm immediately after SES implantation, 2.4 ± 0.4 mm at 6‐month follow‐up and 0.7 ± 0.6 mm at 24‐month follow‐up (ANOVA P < 0.001). By stepwise multiple logistic regression analysis, the only independent predictor of late TLR was stent length (P < 0.001, OR = 1.040, 95% CI = 1.019–1.061). Conclusions : Late TLR was performed in 1.8% of 1,020 native lesions that were patent at 6‐month follow‐up angiogram. Clinical presentations of late TLR was either silent ischemia or recurrent angina, but not acute coronary syndrome. Two‐thirds of late TLR lesions had a focal angiographic ISR pattern. © 2007 Wiley‐Liss, Inc.
Keywords:stent  restenosis  coronary disease
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