In-stent Restenosis Rate Research Articles

Targeted Therapy with a Localized abluminal Groove Low-Dose Sirolimus-Eluting Bioabsorbable Polymer Coronary Stent in Chronic Total Occlusions: The TARGET CTO Non-Inferiority Randomized Trial.

Our objective was to compare the efficacy and safety of a drug-eluting stent featuring an abluminal bioabsorbable sirolimus-containing polymer coating (BP-SES) with an everolimus-eluting stent with a durable polymer (DP-EES) in patients undergoing percutaneous coronary intervention (PCI) for chronic total occlusions (CTOs). TARGET CTO is a multi-center, open-label, non-inferiority trial that randomized patients to either BP-SES or DP-EES in a 1:1 fashion following successful CTO re-canalization. The primary endpoint that was powered for non-inferiority assessment is in-stent late lumen loss (LLL) at 12 months. A total of 206 subjects underwent randomization, with 103 assigned to the BP-SES group and 103 to the DP-EES group. Baseline clinical and angiographic characteristics were comparable. The primary endpoint demonstrated non-inferiority for the BP-SES group compared to the DP-EES group (0.21±0.43 mm vs. 0.21±0.33 mm; p=0.934, 2-sided; difference 0.01mm [BP-SES minus DP-EES]; 95% CI: -0.13 to 0.12 mm; p non-inferiority <0.001,1-sided). No significant differences were observed in secondary angiographic or clinical endpoints. The rates of 12-month in-stent and in-segment binary restenosis in the BP-SES group and the DP-EES group were similar (6.8% vs. 7.5%, p=0.86; and 8.1% vs. 8.8%; p=0.89, respectively). Although there was a trend favoring the BP-SES group, the difference between the BP-SES group and DP-EES group at 12 months in target lesion failure (2.1% vs. 8.0%, p=0.054) and target lesion revascularization (2.1% vs. 7.1%, p=0.089) did not reach statistical significance. No definite or probable stent thromboses were reported in either group. Compared to DP-EES, PCI of CTOs with BP-SES showed similar results in terms of late loss and binary restenosis at the 12-month follow-up. ClinictalTrial.gov, number NCT03040934.

The predictive factors for in-stent restenosis after interventional treatment of chronic carotid artery occlusion.

In-stent restenosis (ISR) is a potential severe complication that occurs in patients with severe carotid artery narrowing after carotid angioplasty and stent placement. However, this phenomenon has not been fully studied in the context of interventional treatment for chronic internal carotid artery occlusion (CICAO). To quantify the ISR rate and identify the risk factors leading to this event. This study included 69 patients with symptomatic CICAO who underwent successful intravascular recanalization at our institution. Clinical information, outcomes, and prognosis of the patients were recorded. The related factors of ISR were analyzed through univariate and multivariate analysis. A total of 11 (15.9%) patients developed a significant ISR > 70% during the follow-up period. Among them, five patients with ISR experienced symptomatic restenosis. Our study found hyperlipidemia (P = 0.017), contralateral internal carotid artery occlusion (P = 0.041), and prolonged radiologic occlusion to recanalization time (P = 0.049) could contribute to the risk of ISR in patients with CICAO. ISR is not rare in patients with CICAO after successful intervention. Hyperlipidemia, contralateral ICA occlusion, and prolonged radiologic occlusion to recanalization time are the risk factors for ISR after treatment in patients with CICAO.

Treatment of unruptured intracranial vertebral artery dissection aneurysms with Flow Diverter compared with conventional stent-assisted coiling—a single-center study

AimFlow diverters (FDs) are being increasingly used off-label for treatment of intracranial vertebral artery dissection aneurysms (IVADAs). However, the safety and efficacy of FDs for unruptured IVADAs remain unclear. This study was performed to investigate whether FDs-alone are safer and more effective than conventional stent-asisted coiling.MethodsWe retrospectively analyzed 152 patients who underwent endovascular stenting from December 2011 to December 2022. The baseline data, aneurysm characteristics, surgical details, perioperative complications, follow-up angiography, and clinical outcomes were collected and compared between patients who underwent stenting with FD-alone versus conventional stent-asisted coiling. Propensity score matching was also conducted.ResultsAll 152 patients underwent successful endovascular therapy. Forty patients were treated with FDs-alone, and 112 were treated with conventional stent-asisted coiling (including 62 with double stents). The complete occlusion rate was 93.75% in the FD group and 93.61% in the conventional stent group (p = 0.979). The complication rate was 5.00% in the FD group and 8.93% in the conventional stent group (p = 0.653). The in-stent restenosis rate was 3.13% in the FD group and 5.32% in the conventional stent group (p = 0.615). The procedure duration was significantly shorter in the FD than conventional stent group (p = 0.034). After propensity score matching, 37 patients with FDs were successfully matched, and the procedure duration was still significantly shorter in the FD group (p = 0.042).ConclusionFD placement is a safe and effective treatment for IVADAs. It is also a simpler procedure with a shorter operation time than conventional stent placement.Trial registration number: ChiCTR2300074171ClinicalTrials.gov ID:NCT06134557

Efficacy and safety of drug-eluting stents versus bare-metal stents in symptomatic intracranial and vertebral artery stenosis: a meta-analysis.

This study aims to present the first comprehensive meta-analysis assessing the effectiveness and safety of drug-eluting stents (DES) versus bare-metal stents (BMS) in treating intracranial and vertebral artery stenosis. A comprehensive examination was undertaken to compare the effectiveness and safety of DES and BMS in individuals experiencing symptomatic stenosis in the intracranial and vertebral arteries through an in-depth analysis of clinical research. We conducted an extensive search across multiple databases including PubMed, Embase, Web of Science, and the Cochrane Library up to September 2024. The emphasis of our investigation was on various outcomes including rates of in-stent restenosis, symptomatic occurrences of in-stent restenosis, incidence of stroke, procedural success, mortality rates, complications associated with the procedure, and any adverse events. Our analysis included 12 studies with a total of 1,243 patients (562 in the DES group and 681 in the BMS group). The findings demonstrated a significantly lower rate of in-stent restenosis in the DES group for both intracranial [odds ratio (OR): 0.23; 95% confidence interval (CI): 0.13 to 0.41; p < 0.00001] and vertebral artery stenosis (OR: 0.38; 95% CI: 0.20 to 0.72; p = 0.003) compared to the BMS group. Additionally, the DES group showed a significantly reduced rate of postoperative strokes in vertebral artery stenosis cases (OR: 0.38; 95% CI: 0.16 to 0.90; p = 0.03), with no significant differences noted in the intracranial artery stenosis comparison (OR: 0.63; 95% CI: 0.20 to 1.95; p = 0.42). The study also revealed no significant disparities in symptomatic in-stent restenosis, procedural success, mortality, adverse effects, and perioperative complications between the two groups across the conditions studied. The comparison indicates that DES significantly reduces the risk of in-stent restenosis and postoperative strokes in patients with vertebral artery stenosis, compared to BMS. For both intracranial and vertebral artery stenosis, DES and BMS exhibit comparable safety profiles. https://www.crd.york.ac.uk/PROSPERO/display_record.php?RecordID=439967.

Intraprocedural and Delayed Plaque Protrusion in Carotid Artery Stenting Using a Dual-Layer Metallic Stent

BackgroundIntravascular ultrasound–determined plaque protrusion (PP) during carotid artery stenting (CAS) using conventional stents is reported in 7.6% to 12% of cases and is associated with periprocedural cerebral embolism. The Casper/Roadsaver stent (CRS) is a dual-layer micromesh stent designed to reduce the risk of PP, with a mesh cell diameter 4-fold smaller size than that of conventional stents. This study investigated the incidence of PP with CRS CAS. MethodsWe prospectively analyzed 89 consecutive arteriosclerotic carotid artery stenoses in 82 patients (64 men; mean age, 76.8 years; 43 symptomatic) who underwent CAS with CRS under intravascular ultrasound. The main end points were the technical success rate, incidences of intraprocedural PP and at 1 week after CAS (delayed PP), incidence of new ipsilateral diffusion-weighted imaging lesion within 48 hours post CAS, and major adverse events (myocardial infarction, stroke, death) within 30 days. Secondary end points were the rate of in-stent restenosis and ipsilateral stroke at 30 days and 12 months. ResultsThe technical success rate was 100%. Intraprocedural PP occurred in 2 patients (2.2%). Delayed PP occurred in 3 additional patients (3.4%). Diffusion-weighted imaging positivity was 24.7%. Major adverse events (minor stroke) occurred in 1 patient (1.1%). In-stent restenosis occurred in 5 patients (6.0%) by 12 months. No ipsilateral stroke occurred during the follow-up. ConclusionsThe incidence of intraprocedural PP with CRS CAS was 2.2%, indicating a significant reduction compared to conventional stents. However, at 7 days new PP had occurred in 3.4% of patients, indicating that patients with CRS should be followed up for delayed PP.

Data-driven reduced order surrogate modeling for coronary in-stent restenosis

Background:The intricate process of coronary in-stent restenosis (ISR) involves the interplay between different mediators, including platelet-derived growth factor, transforming growth factor-β, extracellular matrix, smooth muscle cells, endothelial cells, and drug elution from the stent. Modeling such complex multiphysics phenomena demands extensive computational resources and time. Methods:This paper proposes a novel non-intrusive data-driven reduced order modeling approach for the underlying multiphysics time-dependent parametrized problem. In the offline phase, a 3D convolutional autoencoder, comprising an encoder and decoder, is trained to achieve dimensionality reduction. The encoder condenses the full-order solution into a lower-dimensional latent space, while the decoder facilitates the reconstruction of the full solution from the latent space. To deal with the 5D input datasets (3D geometry + time series + multiple output channels), two ingredients are explored. The first approach incorporates time as an additional parameter and applies 3D convolution on individual time steps, encoding a distinct latent variable for each parameter instance within each time step. The second approach reshapes the 3D geometry into a 2D plane along a less interactive axis and stacks all time steps in the third direction for each parameter instance. This rearrangement generates a larger and complete dataset for one parameter instance, resulting in a singular latent variable across the entire discrete time-series. In both approaches, the multiple outputs are considered automatically in the convolutions. Moreover, Gaussian process regression is applied to establish correlations between the latent variable and the input parameter. Results:The constitutive model reveals a significant acceleration in neointimal growth between 30−60 days post percutaneous coronary intervention (PCI). The surrogate models applying both approaches exhibit high accuracy in pointwise error, with the first approach showcasing smaller errors across the entire evaluation period for all outputs. The parameter study on drug dosage against ISR rates provides noteworthy insights of neointimal growth, where the nonlinear dependence of ISR rates on the peak drug flux exhibits intriguing periodic patterns. Applying the trained model, the rate of ISR is effectively evaluated, and the optimal parameter range for drug dosage is identified. Conclusion:The demonstrated non-intrusive reduced order surrogate model proves to be a powerful tool for predicting ISR outcomes. Moreover, the proposed method lays the foundation for real-time simulations and optimization of PCI parameters.

PROVISIONAL STENTING IN LEFT MAIN STEM DISEASE: LONG-TERM OUTCOMES AND IMPACT ON SIDE BRANCH PERFUSION

Left main stem disease (LMSD) is a severe form of coronary artery disease (CAD) that involves a significant risk of mortality if not treated effectively. Traditionally, coronary artery bypass grafting (CABG) has been the primary method for revascularization in LMSD. However, percutaneous coronary intervention (PCI), especially provisional stenting using drug-eluting stents (DES), has gained popularity for its minimal invasiveness and comparable clinical outcomes. Provisional stenting allows treatment of the main vessel with additional side branch stenting only when needed, reducing complications and stent usage. Objective: The primary objective of this study is to evaluate the long-term outcomes of provisional stenting in patients with LMSD, focusing on its impact on side branch perfusion, in-stent restenosis (ISR), and major adverse cardiac events (MACE). Methods: This retrospective cohort study was conducted at a tertiary care hospital specializing in cardiology between January 2023 and December 2023. A total of 284 patients who underwent provisional stenting for LMSD were included. Fractional flow reserve (FFR) and quantitative coronary angiography (QCA) were used to assess side branch perfusion, with follow-up data including clinical outcomes such as ISR, MACE, and survival rates. Multivariate regression analysis was used to identify predictors of poor outcomes, and Kaplan-Meier survival curves were generated to compare outcomes based on side branch perfusion status. Results: The study found that 77.5% of patients achieved adequate side branch perfusion (FFR &gt; 0.80) after provisional stenting, while 22.5% had impaired perfusion (FFR ≤ 0.80). The incidence of MACE was 10.6%, and ISR was reported in 7.0% of patients during the one-year follow-up period. Kaplan-Meier analysis showed a significant survival benefit for patients with adequate side branch perfusion (Log-Rank p &lt; 0.001). Age and diabetes mellitus were significant predictors of MACE. Conclusion: Provisional stenting in LMSD provides favourable long-term outcomes, particularly in terms of side branch perfusion and reduced MACE. However, a subset of patients, particularly those with diabetes, may require additional interventions. Future studies should focus on improving outcomes in patients with impaired side branch perfusion and exploring the role of advanced imaging techniques in optimizing stenting strategies.

In-Stent Restenosis after Carotid Artery Stent Placement Comparing Maximum Plaque Predilation and Postdilation

PurposeTo compare the incidence of in-stent restenosis (ISR) and ipsilateral neurologic symptoms in patients treated with maximum plaque dilation before stent deployment (max-pre-D) and stent placement followed by angioplasty (post-D) technical variants of carotid artery stent placement at midterm follow-up. Materials and MethodsThis was a single-center, real-world, retrospective comparative study of 307 patients treated in a single vascular surgery unit between 2014 and 2018. The follow-up protocol consisted of duplex ultrasound (US) performed at 1, 6, and 12 months and annually thereafter. The primary outcome was to compare the incidence of ISR ≥70% in patients treated with post-D and max-pre-D. Secondary outcomes included between-group comparison of the following: (a) symptomatic ISR, (b) reinterventions, and (c) ipsilateral neurologic events. ResultsA total of 270 patients (121 in the max-pre-D group and 149 in the post-D group) fulfilling the inclusion criteria were included in the statistical analysis. Mean follow-up was 30.5 months (SD ± 25.6). The ISR rate was 4.1% (n = 5) in the max-pre-D group and 2.7% (n = 4) in the post-D group, with no significant difference in the survival analysis (log-rank P = .664). Symptomatic ISR and retreatment occurred in 3 patients (33.3% of the total ISR for each outcome). Twenty-one ipsilateral neurologic events occurred, 7 in the max-pre-D group (5.8%) and 14 in the post-D group (9.9%), with no statistically significant difference in survival analysis (log-rank P = .315). ConclusionsISR and major neurologic events did not differ significantly between the max-pre-D and post-D groups. Max-pre-D seems to be as effective as post-D technique in midterm follow-up.

ANGIOGRAPHIC PATTERNS AND CLINICAL OUTCOMES OF IN-STENT RESTENOSIS IN DIABETIC PATIENTS FOLLOWING PERCUTANEOUS CORONARY INTERVENTION: A RETROSPECTIVE ANALYSIS

In-stent restenosis (ISR) remains a significant complication after percutaneous coronary intervention (PCI), particularly in diabetic patients. Introducing drug-eluting stents (DES) has substantially reduced restenosis rates compared to bare-metal stents (BMS), yet diabetic patients continue to exhibit higher ISR rates due to their distinct vascular biology. Understanding the angiographic patterns and associated clinical outcomes of ISR in this population is crucial for optimizing treatment strategies. Objective: This study aims to evaluate the angiographic patterns of ISR in diabetic patients and compare the clinical outcomes of these patients to non-diabetic controls following PCI. Methods: A retrospective analysis was conducted on 1,452 patients who underwent coronary stenting and subsequent repeat angiography at a tertiary care centre between January 2021 and December 2023. The study population included 726 diabetic patients and 726 non-diabetic controls. Based on angiographic findings, ISR patterns were classified as focal, diffuse, proliferative, or occlusive. Clinical outcomes, including procedural success of repeat interventions and major adverse cardiovascular events (MACE) within 12 months, were compared between the two groups. Data were analysed using multivariate logistic regression to identify predictors of diffuse ISR patterns. Results: Diabetic patients exhibited significantly higher rates of diffuse ISR (46.3%) compared to nondiabetic patients (34.5%) (p&lt;0.001). Focal ISR was more prevalent in non-diabetics (40.5% vs. 31.1%, p&lt;0.001). Diabetic patients also had a higher incidence of MACE within 12 months (23.4% vs. 15.2%, p&lt;0.001), with myocardial infarction being the most frequent event. Conclusion: Diffuse ISR is more common in diabetic patients and is associated with worse clinical outcomes compared to non-diabetic patients. These findings underscore the need for tailored interventions and close follow-up in diabetic patients post-PCI.

Increased Serum CRP-Albumin Ratio is Independently Associated With In-Stent Restenosis After Carotid Artery Stenting.

Atherosclerotic stenosis of the carotid artery contributes significantly to ischemic strokes. This study investigates the correlation between the C-reactive protein (CRP) to albumin ratio (CAR) and in-stent restenosis (ISR) in patients (n = 529) undergoing carotid artery stenting. Patients were categorized based on ISR occurrence. Cox regression analyses were performed to identify independent predictors of ISR. The ISR rate was 10.3%. Laboratory analysis revealed higher levels of uric acid, CRP, and CAR in the ISR group. Cox regression identified CAR as an independent predictor of ISR (Hazard ratio (HR): 1.13, 95% CI: 1.03-1.24, P = .01), along with diabetes and smoking. A CAR cut-off of 0.28 predicted ISR with 93% sensitivity and 89% specificity (Area under the curve (AUC): 0.945, 95% CI: 0.923-0.963, P < .001). This study establishes a significant association between CAR and ISR in carotid artery stenting patients. The inflammatory response, indicated by CAR, emerges as a crucial factor in ISR development. The study contributes valuable insights into predicting and preventing ISR, emphasizing the potential of CAR as a prognostic biomarker. This easily accessible and cost-effective biomarker could enhance ISR prediction and guide preventive strategies for high-risk patients.

Drug-Eluting Balloons and Drug-Eluting Stents in Diabetic Patients Undergoing Percutaneous Coronary Intervention Due to Restenosis-DM-Dragon Registry.

Background: The rate of in-stent restenosis (ISR) is decreasing; however, it is still a challenge for contemporary invasive cardiologists. Therapeutic methods, including drug-eluting balloons (DEBs), intravascular lithotripsy, excimer laser coronary atherectomy, and imaging-guided percutaneous coronary intervention (PCI) with drug-eluting stents (DES), have been implemented. Patients with diabetes mellitus (DM) are burdened with a higher risk of ISR than the general population. Aims: DM-Dragon is aimed at evaluating the clinical outcomes of ISR treatment with DEBs vs. DES, focusing on patients with co-existing diabetes mellitus. Methods: The DM-Dragon registry is a retrospective study comprising data from nine high-volume PCI centers in Poland. A total of 1117 patients, of whom 473 individuals had DM and were treated with PCI due to ISR, were included. After propensity-score matching (PSM), 198 pairs were created for further analysis. The primary outcome of the study was target lesion revascularization (TLR). Results: In DM patients after PSM, TLR occurred in 21 (10.61%) vs. 20 (10.1%) in non-diabetic patients, p = 0.8690. Rates of target vessel revascularization (TVR), target vessel myocardial infarction, device-oriented composite endpoint (DOCE), and cardiac death did not differ significantly. Among diabetic patients, the risk of all-cause mortality was significantly lower in the DEB group (2.78% vs. 11.11%, HR 3.67 (95% confidence interval, CI) [1.01-13.3), p = 0.0483). Conclusions: PCI with DEBs is almost as effective as DES implantation in DM patients treated for ISR. In DM-Dragon, the rate of all-cause death was significantly lower in patients treated with DEBs. Further large-scale, randomized clinical trials would be needed to support these findings.

Rivaroxaban and Aspirin in Drug-Coated Balloon Angioplasty for Femoropopliteal In-Stent Restenosis: A Retrospective Cohort Study

BackgroundAfter drug-coated balloon (DCB) treatment of the femoropopliteal artery in-stent restenosis (ISR), a certain proportion of patients also experience target lesion restenosis. The purpose of this study was to explore the efficacy and safety of rivaroxaban combined with aspirin in the treatment of ISR after DCB intervention. MethodsPatients who underwent DCB treatment for ISR after femoropopliteal artery intervention at our center from March 2017 to February 2022 were included consecutively. According to the drug treatment after DCB intervention of ISR, the patients were divided into rivaroxaban and aspirin group (RA Group) and dual antiplatelet therapy (DAPT) group. The outcomes of two groups during the 12-month follow-up after DCB intervention were compared. ResultsA total of 92 patients were included in final analysis, with 43 in RA group and 49 in DAPT group. During 12-month follow-up, a total of 15 cases of recurrent ISR were detected, and the recurrence rate of ISR and clinically driven TLR in the RA group were lower than those in the DAPT group (P<0.05). The vascular patency rate in the RA group was higher than that in the DAPT group at 6 and 12 months of follow-up (P<0.05). During the follow-up, there were no adverse events such as death, myocardial infarction, stroke, amputation, or major bleeding, and only a total of 5 cases of minor bleeding occurred. ConclusionCompared with the standard DAPT regimen, rivaroxaban combined with aspirin can safely improve the follow-up outcome after DCB for femoropopliteal ISR.

COMPARATIVE ANALYSIS OF IN-STENT RESTENOSIS IN DIABETIC AND NON-DIABETIC PATIENTS UNDERGOING PERCUTANEOUS CORONARY INTERVENTION IN PAKISTAN

Coronary artery disease (CAD) is a major global killer. Percutaneous coronary intervention (PCI) with drug-eluting stents (DES) has improved CAD treatment. However, in-stent restenosis (ISR) remains a significant issue, especially for diabetic patients. Objective: This study aimed to compare ISR rates between diabetic and non-diabetic patients after PCI in a Pakistani hospital. Methods: We conducted a cross-sectional survey at Hayatabad Medical Complex, Peshawar, from January to December 2023. The study involved 273 patients aged 40-85 who underwent PCI with DES. Participants were split into diabetic and non-diabetic groups. Those with chronic kidney disease, previous coronary artery bypass graft surgery, or incomplete follow-up data were excluded. Data were gathered from medical records. ISR was marked by a luminal diameter reduction of more than 50% within the stent or 5 mm of its edges. We used chi-square tests and logistic regression for analysis, employing SPSS version 26.0. Results: The ISR rate was 23% overall. Diabetic patients showed a higher ISR rate (30%) than non-diabetic patients (16%). Logistic regression revealed diabetes (OR = 2.1, 95% CI: 1.3-3.2, p &lt; 0.01), hypertension (OR = 1.8, 95% CI: 1.1-2.9, p &lt; 0.05), and smoking (OR = 1.6, 95% CI: 1.0-2.5, p &lt; 0.05) as significant predictors of ISR. Conclusion: This study highlights a higher ISR incidence in diabetic patients post-PCI. It underscores the need for meticulous monitoring and tailored strategies for this high-risk group. Managing hypertension, smoking, and dyslipidemia is essential to lower ISR rates and enhance outcomes.

Self-expanding intracranial drug-eluting stent system in patients with symptomatic intracranial atherosclerotic stenosis: initial experience and midterm angiographic follow-up.

Symptomatic intracranial atherosclerotic stenosis (ICAS) is a major cause of ischemic stroke worldwide. In patients undergoing endovascular treatment for ICAS, in-stent restenosis (ISR) is associated with ischemic stroke recurrence. Intracranial drug-eluting self-expanding stent systems (COMETIU; Sinomed Neurovita Technology Inc., CHN) are new devices for treating ICAS. This study evaluated the perioperative experience and medium-term outcomes of COMETIU in 16 patients. We prospectively analyzed 16 patients with ICAS (≥ 70% stenosis) who underwent intravascular therapy between September 4, 2022, and February 1, 2023. The primary outcome was the incidence of ISR at 6 months postoperatively. The secondary efficacy outcomes were device and technical success rates. The secondary safety outcomes included stroke or death within 30 days after the procedure and the cumulative annual rate of recurrent ischemic stroke in the target-vessel territory from 31 days to 6 months and 1 year. A total of 16 patients with 16 intracranial atherosclerotic lesions were treated with 16 COMETIUs. All procedures were performed under general anesthesia with 100% device and technical success rates, with no cases of periprocedural stroke or death. The mean radiographic follow-up duration was at least 6 months postoperatively, and all patients presented for radiographic and clinical follow-up. There were no reported ischemic or hemorrhagic strokes. Angiographic follow-up for all patients revealed no cases of ISR. COMETIU is safe and effective for treating ICAS, with minimal risk during the procedure and a low rate of ISR during medium-term follow-up.

Lipoprotein(a) and long-term in-stent restenosis after percutaneous coronary intervention.

Lipoprotein(a) [Lp(a)] has demonstrated its association with atherosclerosis and myocardial infarction. However, its role in the development of in-stent restenosis (ISR) after percutaneous coronary intervention (PCI) is not clearly established. The aim of this study is to investigate the association between Lp(a) and ISR. A retrospective study of adult patients who underwent successful PCI between January 2006 and December 2017 at the three Mayo Clinic sites and had a preprocedural Lp(a) measurement was conducted. Patients were divided into two groups according to the serum Lp(a) concentration [high Lp(a) ≥ 50 mg/dL and low Lp(a) < 50 mg/dL]. Univariable and multivariable analyses were performed to compare risk of ISR between patients with high Lp(a) vs. those with low Lp(a). A total of 1209 patients were included, with mean age 65.9 ± 11.7 years and 71.8% were male. Median follow-up after baseline PCI was 8.8 [interquartile range (IQR) 7.4] years. Restenosis was observed in 162 (13.4%) patients. Median serum levels of Lp(a) were significantly higher in patients affected by ISR vs. non-affected cases: 27 (IQR 73.8) vs. 20 (IQR 57.5) mg/dL, P = 0.008. The rate of ISR was significantly higher among patients with high Lp(a) vs. patients with low Lp(a) values (17.0% vs. 11.6%, P = 0.010). High Lp(a) values were independently associated with ISR events (hazard ratio 1.67, 95% confidence interval 1.18-2.37, P = 0.004), and this association was more prominent after the first year following the PCI. Lipoprotein(a) is an independent predictor for long-term ISR and should be considered in the evaluation of patients undergoing PCI.

Prevalence and predictors of coronary artery stent re-stenosis in patients with cancer with prior history of percutaneous coronary intervention: A nationwide analysis.

e24018 Background: Data regarding the prevalence, and predictors of development of in-stent restenosis (ISR) in cancer patients undergoing percutaneous coronary intervention (PCI) are scarce. This study aimed to identify factors associated with the development of ISR following PCI in cancer patients. Methods: This is a retrospective cohort study using the National Inpatient Sample(NIS) from 2016 to 2020. Discharges with ICD-10 CM code indicating stenosis of coronary artery stent, and secondary ICD-10 CM code indicating cancer, and prior history of PCI were included. Primary outcome was development of ISR. Multivariate logistic regression model was used to identify predictors of ISR development, and p value of less than 0.05 was considered significant. Results: There were 873,320 patients who met inclusion criteria, among which 4060 patients were admitted for coronary stent re-stenosis. Mean age of included patients was 73, and 31% were females. The prevalence rate of in-stent restenosis was 0.46%. Factors associated with increased odds of development of ISR included diabetes (OR 1.31, 95% CI 1.13-1.51, p &lt; 0.001), dyslipidemia (OR 1.92, 95% CI 1.60-2.31, p &lt; 0.001), congestive heart failure (OR 1.78, 95% CI 1.52-2.06, p &lt; 0.01), carotid disease (OR 1.99, 95% CI 1.43-2.78, p &lt; 0.001), and aortic disease (OR 1.83, 95% CI 1.12-2.98, p 0.01). Age, gender, race, median household income, hospital location and hospital teaching status didn’t exhibit statistically significant increased risk. Conclusions: The prevalence of in-stent restenosis was 0.46%. Appropriate management of risk factors such as diabetes, dyslipidaemia, congestive heart failure is prudent to prevent development of ISR in cancer patients, underscoring the importance of regular cardiology follow up, along with routine cancer care.

Editor's Choice – Development of a Risk Prediction Nomogram for Carotid Re-Stenosis in the One Year RECAST Registry

The long term benefit of carotid angioplasty and stenting (CAS) can be reduced by recurrent stroke related to in stent re-stenosis (ISR). An individualised predictive tool is needed to identify ISR events. A nomogram for individual risk assessment of ISR ≥ 70% after CAS is proposed. A national observational, prospective, multicentre registry was conducted between January 2015 and December 2020. Cohorts of patients with symptomatic or asymptomatic severe carotid stenosis who underwent CAS with a follow up of at least one year after CAS were included. Duplex ultrasound was used to assess in stent re-stenosis. Pre-operative factors were compared between the non-ISR and ISR groups. Kaplan-Meier and Cox regression were used for variable selection. The nomogram was formulated and validated by concordance indices and calibration curves. An in stent re-stenosis risk table was generated for risk stratification. A total of 354 patients were included in the analysis. The ISR rate of ≥ 70% was 7.6% (n= 27). Peripheral arterial disease (hazard ratio [HR] 3.18, 95% confidence interval [CI] 1.23 - 8.24, p= .017), anterior communicating artery absence (HR 3.38, 95% CI 1.27 - 8.94, p= .016), diabetes mellitus (HR 3.34, 95% CI 1.21 - 9.26, p= .020), female sex (HR 2.99, 95% CI 1.04 - 8.60, p= .041), and pre-procedure pathological ultrasound vasoreactivity (HR 3.87, 95% CI 1.43 -10.50, p= .008), as independent risk factors for ISR of ≥70%, were included in the nomogram. The concordance index at 12 and 24 months was 0.83. In low risk groups, ISR of ≥ 70% occurred in 4.8% of patients during follow up compared with 56.2% of patients in the high risk groups (p < .001). The nomogram and risk evaluation score have good predictive ability for ISR. They can be used as practical clinical tools for individualised risk assessment.

Prevalence of In-Stent Restenosis in Patients having Drug Eluting Stents with Lengths Exceeding 40mm: A Single-Center Study

Background: Coronary artery disease (CAD) remains a significant global health challenge, with percutaneous coronary intervention (PCI) being a primary treatment method. The use of long drug-eluting stents (DES) has been linked to varied outcomes, particularly concerning in-stent restenosis (ISR), which may be influenced by factors like stent length and patient comorbidities. Objective: To assess the prevalence of ISR in patients undergoing PCI with long DES (&gt;40mm), considering patient demographics, comorbidities, and lesion characteristics. Methods: This cross-sectional study was conducted at Frontier Corps Teaching Hospital (FCTH) and Lady Reading Hospital in Peshawar, Pakistan, involving 102 patients. The study focused on the frequency of ISR post-angioplasty, particularly in relation to comorbid conditions such as diabetes and hypertension. Data collection included demographics, echocardiographic assessments, and detailed angiogram analysis. Statistical analysis was performed using SPSS version 23.0, with a significance threshold set at p&lt;0.05. Results: The overall prevalence of ISR was found to be 18.63%. Diabetes and hypertension showed a significant association with ISR, with p-values &lt;0.0015. The ISR frequencies for single vessel disease (SVCAD), double vessel disease (DVCAD), and triple vessel disease (TVCAD) were 26.32%, 31.58%, and 42.10%, respectively, with TVCAD showing a statistically significant association (p=0.0185). Conclusion: The study highlights a significant association between long DES and increased ISR rates, particularly in patients with complex coronary anatomies and multiple comorbidities. Shorter stents are recommended to potentially reduce restenosis and improve outcomes in CAD management.

Preoperative Sizing to Lower In-Stent Restenosis in Peripheral Arterial Occlusive Disease

ObjectivesThe primary treatment for lower extremity peripheral arterial occlusive disease (PAOD) is angioplasty-stenting. Its main complication is in-stent restenosis. Poor selection of stent dimensions has been identified as a factor contributing to early in-stent restenosis. The aim of this study is to determine whether the implantation of stents, selected based on arterial morphological reconstruction using sizing software, reduces the occurrence of in-stent restenosis. The study also aims to evaluate the potential benefits of routine preoperative sizing. MethodsBetween January 2016 and December 2020, all patients treated for PAOD through scheduled angioplasty-stenting in our department were included in the study. Using systematic preoperative Computed Tomography Angiography (CTA), precise reconstruction and sizing were performed to select the ideal length and diameter of stents, resulting in the selection of a so-called IDEAL stent. During the procedure, the surgeon implanted either the IDEAL stent or a different one, named the ACTUAL stent, based on intraoperative data and/or availability. We compared the in-stent restenosis rate between IDEAL and ACTUAL stents. ResultsThere were no significant differences in the overall characteristics between the IDEAL and ACTUAL stent groups. The in-stent restenosis rate at one year was 13% (N=28/212, P=0.994) in the IDEAL group and 17% (N=25/149, P=0.994) in the ACTUAL group. Among the ACTUAL stents, a total of 19.6% of stents with a diameter mismatch when chosen based on arteriography showed a significantly higher restenosis rate during the first year of follow-up (P=0.02). ConclusionsOur study did not demonstrate a significant difference in 1-year restenosis rate between the IDEAL and the ACTUAL stents groups. It specifically revealed the significant impact of diameter selection on the intrastent restenosis rate during the first year of follow-up. Stents chosen based on arteriographic criteria, which exhibited diameter discordance, compared to the IDEAL stents group selected using sizing reconstructions, could be either oversized or undersized. This led to a significantly higher restenosis rate at 1 year postoperative.

Self-Apposing Stents in Coronary Chronic Total Occlusions: A Pilot Study

This pilot study assessed the 12-month angiographic and clinical outcomes of self-apposing (SA) stents in patients undergoing chronic total occlusion (CTO) percutaneous coronary intervention (PCI). Self-apposing (SA) stents may decrease incomplete strut apposition and stent strut coverage that are common after CTO PCI. We compared 20 patients who underwent CTO PCI using SA drug-eluting stents (DESs) with 20 matched control patients who underwent CTO PCI using balloon-expandable (BE)-DESs. All patients were followed up clinically for 12 months and had coronary angiography with optical coherence tomography at the end of the follow-up period. The primary end points were stent strut malapposition and strut coverage. The secondary end point was composite major adverse cardiovascular events (MACEs) at 12 months. Both groups had high prevalence of diabetes mellitus, and most of the treated lesions were complex, with 62% having a J-CTO score of ≥3. All CTO PCI techniques were allowed for recanalisation, and 75% of the procedures were guided by intravascular ultrasound. At 12 months, the SA-DES group had fewer malapposed struts (0% [interquartile range (IQR) 0%-0%] vs 4.5% [IQR 0%-20%]; p<0.001) and uncovered struts (0.08% [IQR 0%-1.6%] vs 8.2% [IQR 0%-16%]; p<0.001). However, they showed significantly higher rates of MACEs due to clinically-driven target lesion revascularisation (45% vs 15%; p=0.038). In this pilot study, compared with conventional BE-DESs, SA-DESs used in CTO PCI were associated with fewer malapposed and uncovered stent struts but also with significantly higher rates of in-stent restenosis and MACEs, mainly caused by clinically driven target lesion revascularisation.