Patterns Of In-stent Restenosis Research Articles

Open-Label Multicenter Registry on the Outcomes of In-Stent Restenosis Treated by Balloon Angioplasty with Optical Frequency Domain Imaging in the Superficial Femoral Artery (ISLAND-SFA Study).

Objectives: Balloon angioplasty for in-stent restenosis (ISR) in the superficial femoral artery (SFA) has a high recurrent restenosis rate; however, its mechanism has not been fully and precisely evaluated using high-resolution intravascular imaging. Thus, we aimed to evaluate the relationship between vascular features obtained by optical frequency domain imaging (OFDI) and recurrent restenosis at 6 months.Methods: This was a prospective multicenter single-arm study. OFDI was performed before and after balloon angioplasty, and vascular features were assessed. A multi-layered ISR pattern detected by OFDI was defined as several signal-poor appearances with a high-signal band adjacent to the luminal surface. The primary outcome was defined as recurrent restenosis 6 months after balloon angioplasty.Results: Given that this study was terminated early, only 18 patients completed the 6-month follow-up; of these, 8 developed restenosis. Recurrent restenosis at 6 months tended to be related to a multi-layered ISR pattern (odds ratio (OR), 6.67; 95% confidence interval (CI), 0.81–54.96; p=0.078) and the minimum lumen area (MLA) after balloon angioplasty (OR, 0.71; 95%CI, 0.48–1.04; p=0.077).Conclusion: A multi-layered ISR pattern and MLA after balloon angioplasty detected by OFDI might be risk factors for recurrent ISR in the SFA.

Characteristics of recurrent in-stent restenosis after second- and third-generation drug-eluting stent implantation.

In second- and third-generation drug-eluting stent (DES) era, in-stent restenosis (ISR) is not commonly seen. However, a few patients still need repeat revascularizations for recurrent ISR even after second- and third-generation DES implantation. From January 2012 to March 2017, 2339 lesions underwent second- and third-generation DES (Nobori, Promus Element, Resolute Integrity, Xience, Ultimaster and Synergy) implantation, of which 95 lesions (4.1%) underwent revascularization for first ISR. All lesions were divided into two groups of recurrent ISR group and non-recurrent ISR group. After successful optical coherence tomography (OCT) guided revascularization for all lesions, we investigated characteristics of recurrent ISR, and 2 years follow-up were completed. The mean age was 70.8 ± 11.7 years, and 73.2% were males. Among 56 DES-ISR lesions which were assessed by OCT, recurrent ISR was seen in 33.9% (N = 19) at 2 years follow-up after revascularization for first ISR. Serum low-density lipoprotein-cholesterol (LDL-C) level was higher in recurrent ISR group compared with non-recurrent ISR group (114.1 ± 53.9 mg/dl vs. 90.9 ± 27.8 mg/dl, P = 0.04) and heterogeneous tissue pattern was more frequently found in recurrent ISR group compared with non-recurrent ISR group (63.2% vs. 27.0%, P = 0.03). Multivariate analysis identified a heterogeneous tissue pattern (odds ratio 3.71; 95% confidence interval 1.09-12.59; P = 0.03) as an independent predictor of recurrent restenosis. Recurrent ISR of second- and third-generation DES was associated with heterogeneous tissue pattern of first ISR, and high LDL-C level was associated with recurrence.

Angiographic Restenosis in Coronary Bifurcations Treatment with Regular Drug Eluting Stents and Dedicated Bifurcation Drug-Eluting BiOSS Stents: Analysis Based on Randomized POLBOS I and POLBOS II Studies

Aim The marked variation in bifurcation anatomy has brought about an ongoing search for stents specifically constructed for coronary bifurcations. This study aimed to analyze the angiographic restenosis prevalence and patterns and predictors of different patterns in dedicated bifurcation BiOSS® vs. current generation drug-eluting stents implanted in coronary bifurcation lesions based on data from two clinical trials POLBOS I and II. Methods Dedicated bifurcation BiOSS® stents were compared with drug-eluting stents (DES) in patients with stable coronary artery disease (CAD) or nonST elevation acute coronary syndrome (NSTE-ACS) (POLBOS I: paclitaxel eluting BiOSS® Expert vs. DES; POLBOS II: sirolimus eluting BiOSS® LIM vs. DES). Provisional T-stenting was the default treatment. Morphological pattern of in-stent restenosis according to the modified Mehran classification adopted for bifurcation lesions was assessed with bifurcation dedicated quantitative coronary angiographic software (CAAS 5.11, Pie Medical Imaging BV, the Netherlands). Results In total, 445 patients (222 patients in BiOSS group and 223 patients in DES group) were included into the analysis. In BiOSS group 24 cases of angiographic restenosis (10.8%) were recorded, and in DES group—17 cases (7.6%) at 12 months follow-up (angiographic control rate at follow-up—90.3%). In the BiOSS group most frequent medina classification in restenotic cases was 0.0.1 (25%), whereas in DES—0.0.1 and 0.1.1 (23.5% each). In multivariate regression analysis proximal optimization technique was associated with the lowest chance for restenosis (OR 0.15, 95% CI 0.06–0.33), whereas diabetes on insulin was associated with the highest risk of restenosis (OR 4.21, 95% CI 1.48–11.44). Conclusions The angiographic restenosis pattern and rate was similar between BiOSS stents and DES in coronary bifurcation lesions.

Intravascular Ultrasound Assessment of In-Stent Restenosis in Saphenous Vein Grafts

Outcomes after percutaneous coronary interventions (PCI) in saphenous vein grafts (SVG) are inferior compared with native coronary arteries, but the mechanisms of SVG in-stent restenosis (ISR) have not been well-described. Thus, we aimed to evaluate the patterns of SVG ISR using intravascular ultrasound (IVUS) in 54 SVG ISR lesions. Stent underexpansion was defined as minimum stent area (MSA) <5 mm2. The time from stent implantation to presentation with ISR (9 BMS, 18 first-generation DES, and 27 second-generation DES) was 3.7 ± 3.0 years. IVUS-defined ISR patterns were categorized as mechanical (33%) or biological (67%). Mechanical patterns comprised 10 cases of stent underexpansion (MSA = 4.2 ± 0.9 mm2), 6 stent fractures or deformations, and 2 uncovered aorto-anastomotic lesions. Biological patterns comprised 19 cases of neoatherosclerosis, 13 excessive neointimal hyperplasia (NIH, 65 ± 11%), and 4 thrombi. Compared with biological patterns of ISR, mechanical patterns were more frequently located at the SVG anastomosis (72% vs 39%, p = 0.04) and at the SVG hinge motion site (55% vs 21%, p = 0.02). Although patients with mechanical patterns of ISR presented earlier than those with biological patterns (2.3 vs 4.4 years, p = 0.009), 61% of them were diagnosed >1 year after stent implantation. In conclusion, SVG ISR is dominated by biological patterns including neoatherosclerosis. Mechanical patterns of SVG ISR are associated with earlier presentation and location at graft anastomosis or hinge motion site.

Calcified neoatherosclerosis causing in-stent restenosis: prevalence, predictors, and implications.

Neoatherosclerosis has emerged as a major cause of in-stent restenosis (ISR). Although this entity has been described as a unique process, optical coherence tomography (OCT) enables depiction of distinct morphologic patterns, including the presence of calcified sheets within the stent. We sought to assess prevalence, predictors, and implications of calcified neoatherosclerosis (cNA) as the cause of ISR. From January 2014 to August 2016, 75 consecutive patients with 81 ISR lesions with a clinical indication for revascularization were evaluated by OCT before reintervention. In 13 (16%) lesions, cNA was the predominant pattern of ISR, all of them presenting as very-late (>3 years) ISR. Patients with cNA were older (71±9 vs. 66±10 years, P=0.0157), had worse low-density lipoprotein control (97±29 vs. 81±30 mg/dl, P=0.0746), and received treatment with statins (54 vs. 85%, P=0.006) and angiotensin-converting-enzyme inhibitors/angiotensin receptor blockers (ACEi/ARB) (31 vs. 65%, P=0.003) less frequently compared with patients with other patterns of ISR. Time from stent implantation to ISR [odds ratio (OR)=1.3; 95% confidence interval (CI): 1.1-1.6; P=0.01] and absence of treatment with statins (OR=11.3; 95% CI: 1.7-74; P=0.012) or ACEi/ARB (OR=7.4; 95% CI: 1.3-43; P=0.026) were associated independently with the presence of cNA. During reinterventions, ISR lesions with cNA obtained poorer angiographic (postintervention minimal lumen diameter 1.8±0.4 vs. 2.2±0.5 mm, P=0.0174) and OCT (final stent expansion 83±11 vs. 88±9%, P=0.0896) results. In our cohort of consecutive patients with clinical ISR, one-sixth showed underlying cNA as the predominant substrate of restenosis. This unique underlying substrate is related to the time elapsed from stent implantation and the absence of previous treatment with statins or ACEi/ARB and is associated with poorer acute results after reintervention.

Drug-Coated Balloon Angioplasty for Femoropopliteal In-Stent Restenosis

The optimal revascularization therapy for in-stent restenosis (ISR) of femoropopliteal arteries represents a matter of debate. We investigated the outcomes of patients treated with drug-coated balloon (DCB) angioplasty for ISR of femoropopliteal arteries. Patient-level data from 3 randomized trials of DCB angioplasty for ISR of femoropopliteal arteries were pooled. The primary outcome was target lesion revascularization. The main secondary outcome was recurrent ISR. Other outcomes of interest were ipsilateral amputation, death, Rutherford class improvement, and ankle-brachial index at follow-up. A total of 263 patients randomly assigned to DCB (n=133) or plain balloon angioplasty (n=130) were included in the analysis. After a follow-up of 12 months, patients treated with DCB angioplasty displayed a lower risk for target lesion revascularization (hazard ratio [95% CIs]: 0.25 [0.14-0.46]; P<0.001) and recurrent ISR (0.19 [0.10-0.35]; P<0.001) as compared with those treated with plain balloon angioplasty. There was no significant interaction between the treatment effect for target lesion revascularization and high-risk subgroups of patients such as those with diabetes mellitus, longer lesions, small vessels, moderate to severe underlying calcification, and occlusive pattern of ISR. DCB and plain balloon angioplasty were comparable with respect to other secondary outcomes. In case of femoropopliteal ISR, the percutaneous treatment with DCB angioplasty is associated with superior clinical and antirestenotic efficacy as compared with plain balloon angioplasty at 1-year follow-up, without attrition of efficacy in high-risk subgroups of patients. The long-term durability of DCB angioplasty in this setting remains to be further investigated.

P528Optical coherence tomography patterns of in-stent restenosis after drug-eluting stent implantation: a novel classification and its clinical significance

P528Optical coherence tomography patterns of in-stent restenosis after drug-eluting stent implantation: a novel classification and its clinical significance

Usefulness of Intracoronary Brachytherapy for Patients With Resistant Drug-Eluting Stent Restenosis

In-stent restenosis (ISR) remains a concern even in the drug-eluting stent (DES) era and carries a high risk of recurrence. Brachytherapy is being used as an alternative treatment for resistant ISR, yet the safety and efficacy of this approach has not been well studied. We analyzed the outcomes of 101 patients who underwent coronary brachytherapy for resistant DES ISR. Baseline demographic, clinical, procedural, and outcome data were collected by phone and from electronic records. Comorbidities and overt cardiovascular disease were highly prevalent. Median previous stent layers were 2 with a maximum of 5 layers. Procedural angiographic success rate was 97% and median time to discharge was 1day after brachytherapy. The primary outcome of target vessel revascularization was 24% at 1 year, 32% at 2years, and 42% at 3years. The rate of nonfatal myocardial infarction was 0% at 1year, 3.5% at 2years, and 6% at 3years. The rate of all-cause mortality was 8.5% at 1year, 12% at 2years, and 16% at 3years. We observed only 1 case of late stent thrombosis. After multivariable adjustment, female gender (hazard ratio 2.37, 95% confidence interval 1.02 to 5.52, p= 0.04) and diffuse ISR pattern (hazard ratio 2.95, 95% confidence interval 1.21 to 7.17, p= 0.01) were independently associated with the primary outcome. In conclusion, brachytherapy is feasible for the treatment of resistant DES ISR and is associated with high immediate procedural success and reasonable efficacy in a complex patient population. This approach might be used as an alternative for these patients.

Independent predictors of in-stent restenosis after drug-eluting stent implantation for ostial right coronary artery lesions

ObjectivesWe evaluated the angiographic patterns and predictors of in-stent restenosis (ISR) for ostial lesions of the right coronary artery (RCA) to clarify the mechanism of insoluble restenosis. BackgroundAlthough ISR of the RCA still occurs, limited data is available regarding the associated angiographic findings. MethodsBetween January 2005 and September 2013, we recruited consecutive patients undergoing routine angiography 6–18months after implantation of a drug-eluting stent (DES). Multiple logistic regression analysis was used to determine the independent predictors of ISR, and the adjusted odds ratios (aOR) and 95% confidence intervals (95% CI) were calculated. ResultsRoutine angiography revealed that 45 of 131 patients (34.3%) had RCA-ISR, which were classifiable by occlusion type into ostial (24 cases), proximal (17 cases), diffuse (3 cases), and total (1 case). By multivariable analysis, early generation DES was the only independent predictor of overall ISR (aOR, 3.54; 95% CI, 1.59–7.87; p=0.002). In a subgroup analysis of each focal ISR pattern, early generation DES (aOR, 7.76; 95% CI, 2.15–28.0; p=0.002) was associated with increased risk of ostial ISR. On the contrary, larger stent (aOR, 0.21; 95% CI, 0.05–0.84; p=0.027) was associated with decreased risk of ostial ISR. Furthermore, a ratio of the stent to post-balloon size >1.10 (aOR, 3.93; 95% CI, 1.30–11.8; p=0.002) and good left ventricular contractility (ejection fraction >60%) (aOR, 8.27; 95% CI, 1.76–39.0; p=0.008) were associated with increased risk of proximal ISR when stent fracture was observed. ConclusionThe focal pattern of RCA-ISR was mostly observed after DES implantation, and the mechanisms of proximal and ostial ISR differed.

Optical coherence tomography assessment of in-stent restenosis after percutaneous coronary intervention with two-stent technique in unprotected left main

BackgroundOptical coherence tomography (OCT) has contributed to a better understanding of in-stent restenosis (ISR); however, studies evaluating ISR pattern after two-stent technique in unprotected left main (ULM) are lacking. We aim to evaluate the ISR pattern of proximal LAD and LCX after two-stent technique in ULM. MethodsWe performed OCT in 26 patients with isolated or combined ISR (identified by angiography as >50%) after two stent implantation in the proximal LCX and LAD. Finally, 13 LAD and 22 LCX ISR lesions underwent OCT assessments. OCT analyses were undertaken in the proximal segments of the LAD and LCX. In addition, we compared OCT findings in the flow divider (FD) and lateral wall (LW). ResultsIn both the LAD and LCX, the distance from the ostium to the minimum lumen area (MLA; LAD, 2.00mm [1.00, 3.00]; LCX, 1.00mm [0.00, 1.80] distal to ostium) was short. Uncovered struts were more common on the FD side compared with the LW in the LAD (6.25% [0.00, 20.00] vs 0.00% [0.00, 0.00], respectively, p=0.016) and LCX (11.32% [0.00, 19.44] vs 0.00% [0.00, 4.55], respectively, p<0.001). Conversely, neointimal hyperplasia (NIH) was significantly thicker on the FD side compared with the LW in the LCX (0.31mm [0.19, 0.47] vs 0.15mm [0.09, 0.31], p<0.001). ConclusionsWhile uncovered struts were more commonly found on the FD side of both arteries, NIH was significantly thicker on the FD side compared with the LW in the LCX. These unique findings might indicate inferior outcomes after two-stent techniques in ULM bifurcation lesions.

MECHANISMS AND PATTERNS OF IN-STENT RESTENOSIS AMONG BARE-METAL AND 1ST AND 2ND GENERATION DRUG-ELUTING STENTS: AN OPTICAL COHERENCE TOMOGRAPHY STUDY

Mechanisms and patterns of in-stent restenosis (ISR) comparing bare metal stents (BMS) and 1st and 2nd generation drug-eluting stent (DES) as evaluated by optical coherence tomography (OCT) have not been well delineated. OCT evaluation of ISR (minimum lumen area <3.0mm2) included underexpansion,

Use of intravascular ultrasound vs. optical coherence tomography for mechanism and patterns of in-stent restenosis among bare metal stents and drug eluting stents.

This article is a perspective responses to the "Mechanisms and Patterns of Intravascular Ultrasound In-Stent Restenosis Among Bare Metal Stents and First- and Second-Generation Drug-Eluting Stents" by Goto et al., The above mentioned article outlines the use of intravascular ultrasound (IVUS) in visualizing the patterns and mechanisms of in-stent restenosis (ISR) post percutaneous coronary intervention (PCI). Although IVUS is an appropriate method of choice for this scenario, IVUS has certain limitations which can be overcome by using optical coherent tomography (OCT). OCT is not only able to overcome IVUS's limitations but is also able to provide additional information to enhance the understanding of in-stent restenotic lesions. This article also outlines the future directions for OCT both in clinical and investigation settings.

0510: Predictors of angiographic restenosis after drug eluting stents

Drug eluting stents represent a major advance in coronary revascularization reducing neointimal hyperplasia. However, in-stent restenosis (ISR) was not completely eradicated. The aim of our study was to determine the frequency of the ISR, its angiographic and clinical patterns, the time to onset and different predictors of occurrence. We collected retrospectively clinical and angiographic data of 749 patients hospitalized in the cardiology department of the Military Hospital of Tunis between January 2002 and June 2010 and who underwent percutaneous coronary intervention with drug-eluting stents in 1159 lesions. The exclusion of patients without follow-up reduced the size of the population to 577 patients and 936 lesions. The average age of our patients was 59.65±10 years. The prevalence of clinical ISR was 18.9% per patient and 15.9% per lesion. Its average time to onset was 27.6±20 months. Acute coronary syndrome was the most frequent clinical presentation (83.4%). The focal angiographic form was predominant (64%). Predictors of ISR in univariate analysis were: dyslipidemia (p=0.001), overweight (p=0.001), stenting of proximal left anterior descending artery (p=0.002), severe calcifications (p=0.001), B2 and C lesions (p=0.001), restenosis lesion (p=0.19), reference vessel diameter (p=0.003), minimal lumen diameter (p=0.006), lesion length (p=0.02), sirolimus eluting stent (p=0.001). Protective factors were: use of everolimus eluting stent (p=0.001) and inflation pressure >16 atmospheres (p=0.022). Predictors in multivariate analysis were: restenosis lesion (OR=32, p=0.012) and severe calcifications (OR=38, p=0.016). Inflation pressure >16 atmospheres was a protective factor (OR=27, p=0.017). The ISR remains a potential risk even with drug-eluting stents. A better understanding of its characteristics could provide solutions and reduce its prevalence and complications.

Superficial Femoral Artery Intervention: Creating an Algorithmic Approach for the Use of Old and Novel (Endovascular) Technologies.

Femoropopliteal (FP) disease is a common presentation of peripheral arterial disease (PAD), and a challenging anatomic region for durable treatment. Surgical bypass has historically been the primary therapeutic modality, but has been supplanted in the last decade by endovascular therapy, even with the most complex presentation of disease. Endovascular therapy has the advantage of a more favorable and rapid recovery, while preserving future treatment options. Endovascular management of FP disease, initially with "Plain Old" balloon angioplasty (POBA) has yielded over the years to bare metal stents (BMS), and more recently, to technologies seeking to limit BMS use due to difficult-to-treat patterns of in-stent restenosis (ISR). Despite a myriad number of endovascular devices and strategies, the approach to FP intervention lends itself to an algorithmic schema largely predicated on lesion length, severity of calcification, recanalization method, and clinical goals based upon individual patient status. In addition, treatment costs are a growing consideration in device selection. These criteria can be summarized into what we have termed as a "CADENCE" approach to treatment, an acronym representing the following factors: Clinical scenario, Anatomy, Device performance specifications, Experience/Ease, Novelty, Cost, and Evidence-base (Fig. 1). While the individual components of the CADENCE strategy are not always hierarchical, they combine to give a framework for reasonable interventional strategies for a given patient presentation and lesion appearance. Since there is a notable lack of prospective data for FP interventions, most notably with regard to direct device comparisons, actual practice is often experiential, and further data to guide optimal patient care are needed.

Bioabsorbable drug-eluting vascular scaffold for the treatment of coronary in-stent restenosis: A two center registry.

Coronary in-stent restenosis (ISR) is a clinical problem for which a satisfactory solution has not been found yet. Bioabsorbable drug eluting vascular scaffolds (BVSs) provide transient vessel scaffolding combined with prolonged drug delivery capability. The aim of this study was to investigate the safety of BVS for the treatment of coronary ISR. Between January 2013 and June 2013, 27 patients (31 lesions), presenting with either stable or unstable angina due to coronary ISR, were enrolled in a single arm, prospective, open label registry. Primary end point was the occurrence of target vessel revascularization (TVR) at 12 months. Secondary end point was the composite of death, myocardial infarction and TVR at 12 months. A diffuse ISR pattern was present in 70% of the lesions; mean lesion length was 34.6±15. BVS was successfully implanted in all patients with no in hospital MACE. At twelve months of follow up, MACE rate was 18.5%. One patient died for non-cardiac reason, one patient died due to a possible stent thrombosis and TVR was necessary in 3 patients (11.1%). Our data suggest that BVS is safe and technically feasible for treatment of long and diffuse coronary ISR. These data could be considered hypothesis generator for a randomized clinical trial.

TCTAP A-076 Pattern of In-Stent Restenosis in Saphenous Coronary Vein Grafts – Insight from Optical Coherence Tomography (OCTOPUS Registry)

TCTAP A-076 Pattern of In-Stent Restenosis in Saphenous Coronary Vein Grafts – Insight from Optical Coherence Tomography (OCTOPUS Registry)

Switching types of drug-eluting stents does not prevent repeated in-stent restenosis in patients with coronary drug-eluting stent restenosis

ObjectivesWe treated patients experiencing drug-eluting stent (DES) restenosis with plain old balloon angioplasty (POBA), implantation of the same type of DES [homogeneous drug-eluting stent (HOMO-DES)], or implantation of a different type of DES [heterogeneous drug-eluting stent (HETERO-DES)], and compared the efficacy and safety of these procedures for the prevention of repeated in-stent restenosis (ISR).BackgroundIn patients with de-novo coronary lesions, DES implantation is associated with a markedly reduced restenosis rate as compared with that associated with a bare metal stent and POBA. However, the optimal management strategy for patients with DES ISR remains unknown.Patients and methodsWe identified 191 consecutive DES ISR lesions from 183 patients who required clinically driven revascularization and divided them into three groups according to the treatment: 38 lesions were treated with POBA, 38 with HOMO-DES, and 115 with HETERO-DES.ResultsThe incidence of target lesion revascularization (TLR) was 42.1% (16/38), 15.8% (6/38), and 16.5% (19/115) in the POBA, HOMO-DES, and HETERO-DES groups (POBA vs. HOMO, HETERO-DES; P=0.002, respectively). Multivariate analysis indicated that diabetes [odds ratio (OR), 3.4], hemodialysis (OR, 7.74), nonfocal ISR patterns (OR, 3.35), previous myocardial infarction (OR, 3.26), and POBA (OR, 8.84) were independent predictors of TLR.ConclusionA strategy involving repeated DES implantation was superior to POBA for preventing recurrent restenosis. Treatment with a different type or generation of DES does not appear to reduce the incidence of TLR. Moreover, we identified certain useful factors for facilitating appropriate and early triage in the patients with repeated DES ISR.

Mechanisms of balloon angioplasty and repeat stenting in patients with drug-eluting in-stent restenosis

BackgroundMechanisms of lumen gain during reinterventions in patients with drug-eluting stent (DES) in-stent restenosis (ISR) remain unsettled. MethodsWe sought to assess the mechanisms of acute lumen gain after balloon angioplasty (BA) and repeat drug-eluting stent (DES) implantation in patients with DES-ISR. Following a prospective protocol 29 consecutive patients with DES-ISR were sequentially treated with BA and new DES implantation under a multimodality intracoronary imaging assessment including intravascular ultrasound (IVUS) and optical coherence tomography (OCT). Imaging studies were systematically obtained, at baseline, after BA, and after DES. Results of interventions were compared using volumetric and morphometric (ISR pattern and injury score) analyses. ResultsIVUS and OCT demonstrated that acute lumen gain after BA and DES equally results from a reduction in intra-stent neointimal volume and further DES expansion. As compared with BA, repeat DES implantation not only increased final lumen (baseline 39.6±18.5mm3, post-BA 58.6±26.6mm3, post-DES 84.2±30.8mm3, all p<0.001) but also provided a smoother lumen (injury score 1.57±0.86 vs 0.22±0.26, p<0.001). At the 9th month of angiographic follow-up (86% patients) in-stent late loss was 0.44±0.5mm and 4 patients (16%) developed ISR. The ISR pattern on OCT was not associated with the injury score after interventions or late angiographic findings. Likewise, the injury score did not predict late angiographic outcome. ConclusionsIn patients with DES ISR, lumen gain equally results from a reduction in intra-stent neointimal volume and further DES expansion. As compared with BA, repeat DES implantation provides a larger and smoother coronary lumen.

TCT-658 The Mechanism and Pattern of In-Stent Restenosis Among Bare Metal, 1st Generation, and 2nd Generation Drug-Eluting Stents: An Intravascular Ultrasound Study

The mechanism and patterns of in-stent restenosis (ISR) comparing bare metal stents (BMS) and 1st and 2nd generation drug-eluting stent (DES) as evaluated by intravascular ultrasound (IVUS) have not been well delineated. IVUS evaluation of in-stent restenosis (ISR) included core-lab based

In-stent tissue characteristics detected by optical coherence tomography may affect re-restenosis after cutting balloon angioplasty for in-stent restenosis

Purpose: Cutting balloon angioplasty (CBA) is one of proposed treatments for in-stent restenosis (ISR) but re-restenosis rate after CBA is relatively high. In this study, we investigated whether optical coherence tomography (OCT) detected tissue characteristics can affect re-restenosis after CBA for ISR. Methods: Seventy consecutive patients with ISR who received OCT-guided CBA were enrolled. We divided our patients into TLR group in whom we performed target lesion revascuralization (TLR) for re-restenosis over 3 months after CBA for ISR and non-TLR group in whom we didn't perform TLR. We compared the incidence of drug-eluting stent, phase of ISR, ISR pattern, balloon size, maximal inflation pressure and the OCT parameters of ISR before CBA including restenotic tissue structure/backscatter, microvessels, thrombus and minimum lumen area between the two groups. Results: The rate of TLR was 21.4%. The incidence of microvessels, thrombus and heterogeneous or layered pattern in TLR group (n=15) was significantly higher than non-TLR group (n=55) while the other parameters showed non-significant differences (table). View this table: Table 1 Conclusions: The incidence of microvessels, thrombus and heterogeneous or layered pattern in ISR tissue detected by OCT may affect re-restenosis after CBA for ISR.