Effect of coronary stent overexpansion on lumen size and intimal hyperplasia at follow-up

Abstract

Although previous randomized trials 1 Fischman D. Leon M.B. Baim D.S. Schatz R.A. Savage M.P. Penn I. Detre K. Veltri L. Ricci D. Nobuyoshi M. et al. for the 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 (4143) Google Scholar have demonstrated lower restenosis rates in selected lesions with coronary stents than with conventional balloon angioplasty, in-stent restenosis remains an important clinical problem. 2 Kobayashi Y. De Gregorio J. Kobayashi N. Akiyama T. Reimers B. Finci L. Di Mario C. Colombo A. Stented segment length as an independent predictor of restenosis. J Am Coll Cardiol. 1999; 34: 651-659 Abstract Full Text Full Text PDF PubMed Scopus (257) Google Scholar Previous studies 3 Kuntz R.E. Gibson C.M. Nobuyoshi M. Baim D.S. Generalized model of restenosis after conventional balloon angioplasty, stenting and directional atherectomy. J Am Coll Cardiol. 1993; 21: 15-25 Abstract Full Text PDF PubMed Scopus (493) Google Scholar , 4 Hoffmann R. Mintz G.S. Mehran R. Picahrd A.D. Kent K.M. Satler L.F. Popma J.J. Hogsheng W. Leon M.B. Intravascular ultrasound predictors of angiographic restenosis in lesions treated with Palmaz-Schatz stents. J Am Coll Cardiol. 1997; 31: 43-49 Abstract Full Text Full Text PDF Scopus (272) Google Scholar have demonstrated that a major determinant of the rate of restenosis is the final minimal lumen diameter achieved after intervention, the so-called “bigger is better” principle. As a property of stents, a larger lumen could be achieved compared with that at the reference segment (stent overdilatation). However, previous animal and human clinical percutaneous coronary intervention studies 5 Schwartz R.S. Huber K.C. Murphy J.G. Edwards W.D. Camrud A.R. Vlietstra R.E. Holmes D.R. Restenosis and the proportional neointimal response to coronary artery injury results in a porcine model. J Am Coll Cardiol. 1992; 19: 267-274 Abstract Full Text PDF PubMed Scopus (1048) Google Scholar , 6 Hoffmann R. Mintz G.S. Mehran R. Kent K.M. Pichard A.D. Satler L.F. Leon M.B. Tissue proliferation within and surrounding Palmaz-Schatz stent is dependent on the aggressiveness of stent implantation technique. Am J Cardiol. 1999; 83: 1170-1174 Abstract Full Text Full Text PDF PubMed Scopus (108) Google Scholar , 7 Koyama J. Owa M. Sakurai S. Shimada H. Hikita H. Higashikata T. Ikeda S. Relation between vascular morphologic changes during stent implantation and the magnitude of in-stent neointimal hyperplasia. Am J Cardiol. 2000; 86: 753-758 Abstract Full Text Full Text PDF PubMed Scopus (25) Google Scholar have documented that an increase in vessel wall injury promotes intimal hyperplasia. Thus, the need to achieve a larger acute lumen diameter with stents and the degree of injury is a trade-off. The present study evaluated the effect of stent overdilatation on lumen size and intimal hyperplasia at follow-up.