Intravascular ultrasound evaluation after sirolimus eluting stent implantation for de novo and in-stent restenosis lesions

The aim of this study is to compare the efficacy of sirolimus-eluting stents (SES) on neointimal growth and vessel remodelling for in-stent restenosis versus de novo coronary artery lesions using serial intravascular ultrasound (IVUS). METHODS AND RESULTS: The study population consisted of 86 patients with in-stent restenosis (ISR) (n=41) or de novo lesions (n=45) treated with SES and evaluated by IVUS post-procedure and at follow-up. One 18-mm SES was used for de novo lesions while 16 patients with ISR received >1SES (total stented length 17.9 mm vs 22.0 mm espectively; P=0.004). At follow-up, no differences were observed between the ISR and de novo groups with respect to changes in the mean external elastic membrane (1.7% vs 1.3%; 0.53),plaque behind the stent (1.2% vs 3.4%; P=0.49), and lumen areas (0.7% vs 1.9%; P=0.58). No positive remodelling or edge effect was observed. A gap between stents was observed in two patients with ISR, where more prominent, though non-obstructive, neointimal proliferation was noted. CONCLUSION: Sirolimus-eluting stenting is equally effective at inhibiting neointimal proliferation in de novo and ISR lesions without inducing edge restenosis or positive vascular remodelling...

Fate of Side Branches After Coronary Arterial Sirolimus-Eluting Stent Implantation

The sirolimus-eluting stent (SES) is emerging as a potential solution for the prevention of restenosis. Although the outcome of side branches after stenting with an uncoated metal stent (UMS) has been reported, the fateof side branches after SES implantation is unknown.Furthermore, the absence of spontaneous recanalizationof occluded side branches following intracoronarybrachytherapy has been previously described and hasbeen related to a delayed healing process. We assessedthe procedural and 6-month follow-up angiograms of238 patients enrolled in the RAVEL study, a double-blindcontrolled trial of the SES versus the UMS. Any sidebranch seen on the preprocedure angiogram and subsequentlycovered by the stent was evaluated. The side branch Thrombolysis In Myocardial Infarction (TIMI) flow grade was assessed at baseline and at follow-up by 2 observers. One hundred twenty-eight patients with >1 side branches were identified (63 patients in the SES group with 118 side branches, 65 patients in the UMS group with 124 side branches). Side branch occlusion occurred after stenting in 12 branches (10%) in the SES group and in 9 branches (7%) in the UMS group (p NS). Of these occluded branches, spontaneous recanalization was observed in 11 branches (92%) in the SES group and in 6 branches (67%) in the UMS group at follow-up angiography (p NS). Thus, the fate of side branches after SES implantation is favorable and at least as good as after UMS implantation.

Intravascular ultrasound findings in the multicenter, randomized, double-blind RAVEL (RAndomized study with the sirolimus-eluting Velocity balloon-explandable stent in the treatment of patients with de novo native coronary artery Lesions) trial

The goal of this intravascular ultrasound investigation was to provide a more detailed morphological analys of the local biological effects of the implantation of a sirolimus-eluting stens compared with an uncoated stent. In the RAVEL trial, 238 patients with sigle de novo lesions were randomized to receive either an 18-mm sirolimus-eluting stent (Bx VELOCITY stent, Cordis) or an uncoated stent (Bx velocity Stent)...