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Serial intravascular ultrasound and quantitative coronary angiography after self-expandable wallstent coronary artery implantation

2000; Elsevier BV; Volume: 86; Issue: 9 Linguagem: Inglês

10.1016/s0002-9149(00)01140-1

1879-1913

Andreas König, Volker Klauß, Evelyn Regar, Johannes Rieber, Gianni Casella, K. Theisen, Harald Mudra,

Cardiac Imaging and Diagnostics

The role of coronary stenting has expanded rapidly in the treatment of atherosclerotic coronary lesions during the last decade. 1 Serruys P.W. Strauss B.H. Beatt K.J. Bertrand M.E. Puel J. Rickards A.F. Meier B. Goy J.J. Vogt P. Kappenberger L. Sigwart U. Angiographic follow-up after placement of a self-expanding coronary-artery stent. N Engl J Med. 1991; 324: 13-17 Crossref PubMed Scopus (649) Google Scholar , 2 Serruys P.W. de Jaegere P. Kiemeneij F. Macaya C. Rutsch W. Heyndrickx G. Emanuelsson H. Marco J. Legrand V. Materne P. et al. Benestent Study GroupA comparison of balloon-expandable-stent implantation with balloon angioplasty in patients with coronary artery disease. N Engl J Med. 1994; 331: 489-495 Crossref PubMed Scopus (4429) Google Scholar , 3 Roubin G.S. Cannon A.D. Agrawal S.K. Macander P.J. Dean L.S. Baxley W.A. Breland J. Intracoronary stenting for acute and threatened closure complicating percutaneous transluminal coronary angioplasty. Circulation. 1992; 85: 916-927 Crossref PubMed Scopus (577) Google Scholar , 4 Fischman D.L. Leon M.B. Baim D.S. Schatz R.A. Savage M.P. Penn I. Detre K. Veltri L. Ricci D. Nobuyoshi M. et al. Stent Restenosis Study InvestigatorsA randomized comparison of coronary stent placement and balloon angioplasty in the treatment of coronary artery disease. N Engl J Med. 1994; 331: 496-501 Crossref PubMed Scopus (4181) Google Scholar However, in-stent restenosis remains a major problem with neointimal in-growth as the predominant mechanism for stent restenosis in slotted tube stents as shown by serial intravascular ultrasound (IVUS) investigations. 5 Mudra H. Regar E. Klauss V. Werner F. Henneke K.H. Sbarouni E. Theisen K. Serial follow-up after optimized ultrasound-guided deployment of Palmaz-Schatz stents. In-stent neointimal proliferation without significant reference segment response. Circulation. 1997; 95: 363-370 Crossref PubMed Scopus (187) Google Scholar , 6 Hoffmann R. Mintz G.S. Dussailant G.R. Popma J.J. Pichard A.D. Satler L.F. Kent K.M. Griffin J. Leon M.B. Patterns and mechanisms of instent restenosis. A serial intravascular ultrasound study. Circulation. 1996; 94: 1247-1254 Crossref PubMed Scopus (1250) Google Scholar IVUS-guided stenting has resulted in additional lumen gain and reduction of incidence of stent thrombosis in slotted tube stents. 7 Mudra H. Klauss V. Blasini R. Kroetz M. Rieber J. Regar E. Theisen K. Ultrasound guidance of Palmaz-Schatz intracoronary stenting with a combined intravascular ultrasound balloon catheter. Circulation. 1994; 90: 1252-1261 Crossref PubMed Scopus (123) Google Scholar , 8 Colombo A. Hall P. Nakamura S. Almagor Y. Maiello L. Martini G. Gaglione A. Goldberg S.L. Tobis J.M. Intracoronary stenting without anticoagulation accomplished with intravascular ultrasound guidance. Circulation. 1995; 91: 1891-1893 Crossref PubMed Scopus (1373) Google Scholar The achievement of certain stent expansion criteria may improve long-term angiographic and clinical outcome. Until now, these approaches have been developed and tested mainly with the Palmaz-Schatz stent (Cordis, Johnson & Johnson, Warren, New Jersey). 9 De Jaegere P. Mudra H. Figulla H. Almagor Y. Doucet S. Penn I. Colombo A. Hamm C. Bartorelli A. Rothman M. et al. Intravascular ultrasound-guided stent deployment. Immediate and 6 months clinical and angiographic results from the Multicenter Ultrasound Stenting in Coronaries Study. Eur Heart J. 1998; 19: 1214-1223 Crossref PubMed Scopus (450) Google Scholar , 10 Mudra H. Macaya C. Zahn R. Grip L. Di Mario C. Rutsch W. Voudris V. Schächinger V. Henneke K.H. Interim analysis of the OPTimization with ICUS to reduce stent restenosis (OPTICUS) trial. Circulation. 1998; 98: I-1908 Google Scholar The deployment characteristics of the Wallstent (Schneider AG, Bülach, Switzerland) differ considerably from that of slotted tube stents. 1 Serruys P.W. Strauss B.H. Beatt K.J. Bertrand M.E. Puel J. Rickards A.F. Meier B. Goy J.J. Vogt P. Kappenberger L. Sigwart U. Angiographic follow-up after placement of a self-expanding coronary-artery stent. N Engl J Med. 1991; 324: 13-17 Crossref PubMed Scopus (649) Google Scholar , 11 Strauss B.H. Serruys P.W. Bertrand M.E. Puel J. Meier B. Goy J.J. Kappenberger L. Rickards A.F. Sigwart U. Quantitative angioghraphic follow-up of the coronary Wallstent in native vessels and bypass grafts (European experience—March 1986 to March 1990). Am J Cardiol. 1992; 69: 475-481 Abstract Full Text PDF PubMed Scopus (87) Google Scholar The second generation, self-expandable Wallstent exerts a long-term radial pressure on the vessel wall that may induce exaggerated neointimal in-growth.