Long-term follow up of diabetic patients treated with sirolimus-eluting stents. An angiographic and three-dimensional intravascular ultrasound study.

BACKGROUND: Sirolimus-eluting stents (SES) have already demonstrated their long-term effectiveness in suppressing neointimal hyperplasia in non-high risk patients. The long-term follow up of diabetic patients treated with SES has not been yet evaluated. METHODS AND RESULTS: Quantitative coronary angiography and intravascular ultrasound analysis were performed in 35 diabetic patients treated with a SES at short- (6.0 +/- 1.0 months) and long-term (18.5 +/- 4.9 months) follow up. There were no significant changes in the in-stent minimum lumen diameter (MLD) between short- and long-term follow up (2.69 +/- 0.46 vs. 2.61 +/- 0.44 mm; p = 0.5), as well as in the in-lesion MLD (2.38 +/- 0.54 vs. 2.30 +/- 0.62 mm; p = 0.6). None of the patients reached binary restenosis (diameter stenosis > 50%) at either follow-up periods. Stent obstruction volume by 3-D IVUS was very small at short-term follow up and has remained virtually the same at long-term follow up (3.4% vs. 3.5%; p = 0.8). There were no aneurysm formations, late stent strut malappositions or late stent thromboses. CONCLUSION: The present study demonstrates the 18-month efficacy and safety of SES for the treatment of diabetic patients without the so-called late catch-up phenomenon.

Long-term follow up of diabetic patients treated with sirolimus-eluting stents: an angiographic and three-dimensional intravascular ultrasound study

Background: Sirolimus-eluting stents (SES) have already demonstrated their long-term effectiveness in suppressing neointimal hyperplasia in non-high risk patients. The long-term follow up of diabetic patients treated with SES has not been yet evaluated.Methods and Results: Quantitative coronary angiography and intravascular ultrasound analysis were performed in 35 diabetic patients treated with a SES at short- (6.0 ± 1.0 months) and long-term (18.5 ± 4.9 months) follow up. There were no significant changes in the in-stent minimum lumen diameter (MLD) between short- and long-term follow up (2.69 ± 0.46 vs. 2.61 ± 0.44 mm; p = 0.5), as well as in the in-lesion MLD (2.38 ± 0.54 vs. 2.30 ± 0.62 mm; p = 0.6). None of the patients reached binary restenosis (diameter stenosis > 50%) at either follow-up periods. Stent obstruction volume by 3-D IVUS was very small at short-term follow up and has remained virtually the same at long-term follow up (3.4% vs. 3.5%; p = 0.8). There were no aneurysm formations, late stent strut malappositions or late stent thromboses.Conclusion: The present study demonstrates the 18-month efficacy and safety of SES for the treatment of diabetic patients without the so-called late catch-up phenomenon.Introduction Diabetes mellitus is associated with more aggressive coronary artery disease with almost 4 times the mortality rate and worse outcomes (including restenosis) after percutaneous coronary intervention.[1-3] Stent implantation has become the percutaneous treatment of choice among patients with coronary artery disease and has improved clinical outcomes compared with balloon angioplasty, even in diabetic patients.[4] However, in-stent restenosis, as well as target lesion revascularization, remain a major problem in diabetic patients treated with bare metal stents.[5,6] In the last 5 years, drug-eluting stents (DES) have emerged as the most promising percutaneous device for the treatment of coronary artery disease. Building on the initial results of the first-in-man (FIM) registry,[7] sirolimus-eluting stents (SES) have shown superior results in several randomized trials and large registries.[8-10] Basically, SES have been shown to significantly reduce restenosis at short-term follow up (4 to 8 months) in almost all clinical conditions and lesion subsets.[11-13] However, few data exist regarding the long-term inhibitory effect of sirolimus, especially in diabetic patients.

[Adenosine myocardial perfusion SPECT with Tc-99m-MIBI in patients with obstructive coronary artery disease: correlation between quantitative coronary angiography and intravascular ultrasound measurements]. / Cintilografia do miocárdio com tecnécio 99m-MIBI e administração de adenosina em portadores de doença arterial coronária: correlação dos resultados com a angiografia coronária e o ultra-som intracoronário.

OBJECTIVE: To correlate myocardial perfusion scintigraphy (MPS) with Tc-99m-MIBI and adenosine infusion using quantitative coronary angiography (QCA) and intravascular ultrasound (IVUS). METHODS: Seventy patients with coronary artery disease (CAD) referred for myocardial perfusion scintigraphy (MPS) with MIBI and adenosine were studied. Clinical, electrocardiographic (ECG), and scintigraphic findings were correlated with variables of visual and quantitative angiographic analysis, as well as to those of IVUS. RESULTS: The mean age of patients was 60.6 years, and 39 were male. Coronary angiography showed percentage of diameter stenosis (% DS) of 49.94% in 105 arteries, 83 of which were re-evaluated by QCA (79%), mean of 44.20%, p<0.05. ST-segment depression during adenosine infusion was associated with higher degrees of % DS (55.0% vs. 47.8%), p<0.05). Scintigraphic ischemia was correlated with greater cross-sectional area of lumen obstruction by IVUS (% CSA). Clinical, ECG, and IVUS findings were considered together and expressed as global ischemic versus non-ischemic responses. Ischemia was associated with lower values of minimal lumen diameter (MLD) and minimal lumen area (MLA) determined by QCA and IVUS. CONCLUSION: Tc-99m-MIBI and adenosine myocardial SPECT is correlated with % CSA on IVUS, perfusion images considered. Global results assessment showed association between lumen diameter and area at obstructed sites as determined by QCA and IVUS.

Cintilografia do miocárdio com tecnécio 99m-MIBI e administração de adenosina em portadores de doença arterial coronária: correlação dos resultados com a angiografia coronária e o ultra-som intracoronário / Adenosine myocardial perfusion SPECT with Tc-99m-MIBI in patients with obstructive coronary artery disease: correlation between quantitative coronary angiography and intravascular ultrasound measurements

OBJETIVO: Estabelecer a correlação da cintilografia de perfusão do miocárdio (CPM) com Tecnécio 99m-MIBI (MIBI) e injeção de adenosina, empregando a angiografia coronária quantitativa (ACQ) e o ultra-som intracoronário (UIC) como comparação. MÉTODOS: Estudo de 70 pacientes com doença arterial coronária (DAC), encaminhados à CPM com MIBI e adenosina. As manifestações clínicas, do eletrocardiograma (ECG) e os resultados das imagens foram correlacionadas às variáveis da análise visual e quantitativa da angiografia, bem como ao UIC. RESULTADOS: A média de idades foi de 60,6 anos, com 39 pacientes do sexo masculino. A angiografia coronária evidenciou estenose do diâmetro da luz (E por cento) de 49,94 por cento em 105 artérias, com reavaliação à ACQ em 83 artérias (79 por cento) e média de 44,20 por cento, p<0,05. Infradesnível de ST durante adenosina associou-se a maiores graus de E por cento (55,0 por cento vs 47,8 por cento), p<0,05). A isquemia cintilográfica correlacionou-se a maior área porcentual de obstrução da luz pelo UIC (AO por cento). Os achados clínicos, do ECG e das imagens foram considerados em conjunto e expressos como respostas globais isquêmicas versus não-isquêmicas . A isquemia associou-se a menores valores do diâmetro mínimo da luz (DML) e da área mínima da luz (AML), obtidos à ACQ e ao UIC. CONCLUSAO: A cintilografia do miocárdio com 99mTc-MIBI e adenosina correlaciona-se à AO por cento ao UIC, considerando-se as imagens de perfusão. Na avaliação dos resultados globais da prova observa-se associação com os diâmetros e as áreas da luz nos locais de obstrução, obtidos à ACQ e ao UIC.

Angiographic and intravascular ultrasound findings of the late catch-up phenomenon after intracoronary beta-radiation for the treatment of in-stent restenosis.

We report one-year angiographic and intravascular ultrasound (IVUS) outcomes of in-stent restenosis (ISR) patients treated with intravascular brachytherapy (IVBT). The benefit of IVBT for treating ISR is well documented. However, few data exist on significant angiographic and intravascular ultrasonic in-stent lumen deterioration beyond the habitual 6-month analysis after the index radiation procedure or so-called late catch-up process in the treatment of ISR. Twenty-five consecutive patients with ISR were treated with IVBT using the Beta-Cath System (a 40 mm 90 Sr per 90 gamma source). Quantitative angiographic and IVUS analysis was performed in all of them at 6 and 12 months. IVBT was successful in all patients. Four patients (16%) developed recurrent angiographic binary restenosis at 6-month follow-up, all located within the adjacent reference segments, with 2 being associated with geographical miss. An additional 4 patients (16%) presented with recurrent ISR at 12-month follow-up, all within the stented segment. Significant in-stent lumen loss (0.16 +/- 0.42 mm to 0.34 +/- 0.46 mm; p = 0.008) and in-stent intimal hyperplasia growth (+11.2 +/- 0.48 mm3; p = 0.03) was observed between 6 and 12 months. Intracoronary beta-radiation for the treatment of ISR was associated with significant luminal deterioration (late catch-up) within the stents between 6 and 12 months due to an important late progression of in-stent intimal hyperplasia.

Intracoronary ultrasound assessment late after the arterial switch operation for transposition of the great arteries.

OBJECTIVES: This research was undertaken to assess the status of the coronary wall morphology late after the arterial switch operation (ASO) for transposition of the great arteries employing intravascular ultrasound (IVUS). BACKGROUND: Long-term patency of the reimplanted coronary arteries is a key issue after ASO. Follow-up studies have demonstrated coronary obstruction in up to 8% of patients that may be related to progressive fibrocellular intimal thickening. METHODS: Twenty-two asymptomatic children were enrolled at a median age of 9.5 years (range 5 to 22 years); IVUS images were obtained in 20 children at cardiac catheterization 5.0 to 21.6 years after the operation (in two cases IVUS study was not feasible due to technical constraints). Quantitative analysis was performed in 37 coronary arteries involving segments with a mean length of 28.4 +/- 1.8 mm. RESULTS: Thirty-three arteries (89%) displayed variable degrees of proximal eccentric intimal proliferation, with the maximal intimal thickening being 0.26 +/- 0.14 mm (range 0.06 to 0.71 mm) at the most thickened site. According to the Stanford classification, all children had coronary artery involvement with 50% having moderate-to-severe lesions (>0.3 mm). No risk factors for such abnormalities were encountered, including age, origin of the coronary arteries, hemodynamics, and follow-up duration after surgery. CONCLUSIONS: Intravascular ultrasound assessment late after the ASO revealed proximal eccentric intimal thickening in most of the studied vessels. This observation suggests the development of early atherosclerosis in the reimplanted coronary arteries, which may have a role in the genesis of late coronary events.

Intracoronary ultrasound assessment late after the arterial switch operation for transposition of the great arteries

This research was undertaken to assess the status of the coronary wall morphology late after the arterial swith operation (ASO) for transposition of the great arteries employing intravascular ultrasound(IVUS).Long-term patency of the reimplanted coronary arteries is a key issue after ASO. Follow-up studies have demonstrated coronary obstruction in up to 8% o9f patients that may be related to progressive fibrocellular intimal thickening.Twenty-two asymptomatic chidren were enrolled at a median age of 9.5 years (range 5 to 22 years); IVUS images were obtained in 20 children at cardiac catheterization 5.0 to 21.6 years after the operation (in two cases IVUS study was not feasible duo to technical constraints)...

Intracoronary ultrasound assessment late after the arterial witch operation for transposition of the great arteries

This research was undertaken to assess the status of the coronary wall morphology late after the arterial switch operation (ASO) for transposition of the great arteries employing intravascular ultrasound (IVUS). BACKGROUND Long-term patency of the reimplanted coronary arteries is a key issue after ASO. Follow-up studies have demonstrated coronary obstruction in up to 8% of patients that may be related to progressive fibrocellular intimal thickening. METHODS Twenty-two asymptomatic children were

enrolled at a median age of 9.5 years (range 5 to 22 years); IVUS images were obtained in 20 children at cardiac catheterization 5.0 to 21.6 years after the operation (in two cases IVUS study was not feasible due to technical constraints). Quantitative analysis was performed in 37 coronary arteries involving segments with a mean

length of 28.4 1.8 mm. RESULTS Thirty-three arteries (89%) displayed variable degrees of proximal eccentric intimal proliferation, with the maximal intimal thickening being 0.26 0.14 mm (range 0.06 to 0.71 mm) at the most thickened site. According to the Stanford classification, all children had coronary

artery involvement with 50% having moderate-to-severe lesions ( 0.3 mm). No risk factors for such abnormalities were encountered, including age, origin of the coronary arteries, hemodynamics, and follow-up duration after surgery. CONCLUSIONS Intravascular ultrasound assessment late after the ASO revealed proximal eccentric intimal thickening in most of the studied vessels. This observation suggests the development of early atherosclerosis in the reimplanted coronary arteries, which may have a role in the genesis of