A patient presented with exertional chest pain two months prior to admission. Coronary angiography revealed a subocclusive stenosis within the boundaries of the stent. Optical coherence tomography showed remarkable intimal growth inside the stent, which demonstrated a heterogeneous appearance including low-intensity areas. These findings were congruent with the morphology of fibroatheroma in the native coronary artery and suggested that new atherosclerotic progression of the intima within the stent had occurred over 17 years following bare metal stent implantation. To the best of our knowledge, this is one of the most delayed instances of a bare metal stent restenosis described in the medical literature.
Aged ; Angioplasty, Balloon, Coronary ; Coronary Restenosis/*diagnosis ; Female ; Humans ; Tomography, Optical Coherence/*methods

BACKGROUNDIn-stent restenosis is a common complication after stent implantation. However, the assessment of stent lumen in computed tomography (CT) coronary angiography is limited by multiple factors. Our study aimed to evaluate the accuracy and the suspected affecting factors in diagnosing coronary in-stent restenosis by dual-source CT (DSCT) compared with coronary angiography.

METHODSOne hundred and fifteen stents in 50 patients were evaluated with DSCT before coronary angiography for the detection of coronary in-stent restenosis (≥ 50% luminal narrowing). Patency of each stent was analyzed by two independent expert radiologists blinded to the results of coronary angiography. The relationship between diagnostic accuracy and the suspected factors including age, body mass index (BMI), heart rate, variation of heart rate, radiation dose, image quality, location and stent characteristics (type, material, diameter, length and strut thickness) was assessed with both univariate and multivariate analysis. The fitting of a Logistic regression model was evaluated using a receiver operating characteristic (ROC) curve.

RESULTSMean stent diameter was (2.9 ± 0.4) mm. Sensitivity, specificity, positive and negative predictive values and accuracy of DSCT in detection of in-stent restenosis were 69.2%, 91.2%, 50.0%, 95.9%, and 88.7%, respectively. In a subgroup of stents with a diameter ≥ 3.0 mm, sensitivity, specificity, positive and negative predictive values and accuracy were 100.0%, 96.5%, 75.0%, 100.0%, and 96.8%, respectively. Stent diameter < 3.0 mm and poor image quality were associated with poor diagnostic accuracy (P < 0.05). The area under curve of ROC was 0.79.

CONCLUSIONDSCT can provide high accuracy for the assessment of in-stent restenosis in stents with a diameter = 3.0 mm, and can play an important role in ruling out in-stent restenosis.

Adult ; Aged ; Aged, 80 and over ; Body Mass Index ; Coronary Angiography ; methods ; Coronary Restenosis ; diagnosis ; diagnostic imaging ; Female ; Humans ; Male ; Middle Aged ; Tomography, X-Ray Computed ; methods

Stent fracture (SF) has been implicated as a risk factor for in-stent restenosis, but its incidence and clinical characteristics are not well established. Therefore we investigated the conditions associated with stent fracture and its clinical presentation and outcome. Between 2004 and 2007, consecutive cases of SF were collected from the Seoul National University Hospital. Clinical characteristics and outcome of patients with fractured stents were compared with a ten-fold cohort of age and gender matched controls (n = 236). A total of 4,845 patients received percutaneous coronary intervention and 3,315 patients (68.4%) underwent angiographic follow-up. Twenty-eight fractured stents were observed in 24 patients. The incidence of SF was 0.89% for sirolimus-eluting stents (SES) and 0.09% for paclitaxel-eluting stents. Chronic kidney disease, stent implantation in the right coronary artery (RCA), and SES use were independent predictors of drug-eluting stent fracture by multivariate analysis. SF was significantly associated with binary restenosis (11.4% vs 41.7%, P < 0.001) and increased risk of target lesion revascularization (8.1% vs 33.3%, P = 0.001). Patients with SF but without significant restenosis showed excellent outcome despite only medical treatment. In conclusion, SF is associated with increased rates of restenosis and repeat revascularization. Significant risk factors include chronic kidney disease, RCA intervention, and SES use.
Age Factors ; Aged ; Cardiovascular Agents/administration & dosage ; Cohort Studies ; Coronary Angiography ; Coronary Restenosis/diagnosis/*epidemiology/prevention & control ; Coronary Stenosis/radiography/therapy ; *Drug-Eluting Stents ; Female ; Humans ; Male ; Middle Aged ; Paclitaxel/administration & dosage ; *Prosthesis Failure ; Registries ; Risk Factors ; Sex Factors ; Sirolimus/administration & dosage

Stent fracture (SF) has been implicated as a risk factor for in-stent restenosis, but its incidence and clinical characteristics are not well established. Therefore we investigated the conditions associated with stent fracture and its clinical presentation and outcome. Between 2004 and 2007, consecutive cases of SF were collected from the Seoul National University Hospital. Clinical characteristics and outcome of patients with fractured stents were compared with a ten-fold cohort of age and gender matched controls (n = 236). A total of 4,845 patients received percutaneous coronary intervention and 3,315 patients (68.4%) underwent angiographic follow-up. Twenty-eight fractured stents were observed in 24 patients. The incidence of SF was 0.89% for sirolimus-eluting stents (SES) and 0.09% for paclitaxel-eluting stents. Chronic kidney disease, stent implantation in the right coronary artery (RCA), and SES use were independent predictors of drug-eluting stent fracture by multivariate analysis. SF was significantly associated with binary restenosis (11.4% vs 41.7%, P < 0.001) and increased risk of target lesion revascularization (8.1% vs 33.3%, P = 0.001). Patients with SF but without significant restenosis showed excellent outcome despite only medical treatment. In conclusion, SF is associated with increased rates of restenosis and repeat revascularization. Significant risk factors include chronic kidney disease, RCA intervention, and SES use.
Age Factors ; Aged ; Cardiovascular Agents/administration & dosage ; Cohort Studies ; Coronary Angiography ; Coronary Restenosis/diagnosis/*epidemiology/prevention & control ; Coronary Stenosis/radiography/therapy ; *Drug-Eluting Stents ; Female ; Humans ; Male ; Middle Aged ; Paclitaxel/administration & dosage ; *Prosthesis Failure ; Registries ; Risk Factors ; Sex Factors ; Sirolimus/administration & dosage

The aim of this study was to examine the anti-proliferative and anti-inflammatory effects of ezetimibe/simvastatin (E/S) after drug-eluting stent (DES) implantation in a porcine coronary restenosis model. Pigs were randomized into two groups in which the coronary arteries (23 pigs) had DES. Stents were deployed with oversizing (stent/artery ratio 1.3:1) in porcine coronary arteries. Fifteen pigs were taken 10/20 mg of E/S and eight pigs were not taken E/S. Histopathologic analysis was assessed at 28 days after stenting. In neointima, most inflammatory cells were lymphohistiocytes. Lymphohistiocyte count was not different between two groups (337+/-227 vs. 443+/-366 cells, P=0.292), but neointima area was significantly smaller (1.00+/-0.49 mm2 vs. 1.69+/-0.98 mm2, P=0.021) and percent area stenosis was significantly lower (23.3+/-10% vs. 39+/-19%, P=0.007) in E/S group compared with control group. There were no significant differences in fibrin score (1.99+/-0.79 vs. 1.81+/-0.88, P=0.49), endothelial score (1.75+/-0.66 vs. 1.80+/-0.59, P=0.79), and the percent of endothelium covered lumen (43+/-21% vs. 45+/-21%, P=0.84) between E/S group and control group. Combined therapy with ezetimibe and simvastatin inhibits neointimal hyperplasia, but does not inhibit inflammatory infiltration and arterial healing after DES implantation in a porcine coronary restenosis model.
Animals ; Anticholesteremic Agents/administration & dosage ; Azetidines/*administration & dosage ; Coronary Restenosis/diagnosis/drug therapy/*etiology ; *Disease Models, Animal ; Drug Combinations ; Drug Implants/administration & dosage ; Drug-Eluting Stents/*adverse effects ; Female ; Graft Occlusion, Vascular/diagnosis/*drug therapy/*etiology ; Humans ; Hydroxymethylglutaryl-CoA Reductase Inhibitors/administration & dosage ; Simvastatin/*administration & dosage ; Swine ; Treatment Outcome

OBJECTIVETo assess the efficacy and safety of implantation of multiple drug-eluting stents.

METHODSA retrospective study of 151 cases was conducted, including 34 with implantation of at least 3 drug-eluting stents in the coronary artery (MS group), 53 with implantation of two stents (TS group), and 64 with a single stent (OS group). The incidence of major adverse cardiovascular event (MACE) and restenosis was evaluated.

RESULTSNo significant difference was found between the 3 groups in the incidence of MACE or in the stent thrombosis rate 30 days after the implantation. Follow-up of the patients for 6 months still showed comparable restenosis rate and MACE incidence between the 3 groups.

CONCLUSIONImplantation of multiple drug-eluting stents does not increase the risk of restenosis or MACE, and has comparable safety and efficacy with implantation of single and two stents.

Angioplasty, Balloon, Coronary ; adverse effects ; methods ; Coronary Artery Disease ; therapy ; Coronary Restenosis ; diagnosis ; etiology ; Drug-Eluting Stents ; Female ; Follow-Up Studies ; Humans ; Male ; Middle Aged ; Retrospective Studies ; Treatment Outcome

This is a retrospective study aimed at the clinical application of 64-slice computed tomography angiography (CTA) in evaluation the lumen before and after coronary artery stent implantation. We collected the coronary artery imaging data of 46 patients undergoing 64-slice CT before coronary artery stent implantation from July 2006 through May 2007; we also collected the data of 21 patients with 34 coronary artery stents in the same period to determine the diagnostic accuracy of CTA before and after coronary artery stent implantation. The results showed that, in 46 patients, 64-slice CT enabled the visualization of the entire coronary tree with diagnostic image quality. Sensitivity, specificity, and accuracy for the detection of stenosis > or = 50% were 92.11%, 95.64% and 94.97%, respectively. In 21 patients with 34 stents implanted, 23 (67.65%) stents showed no stenosis, 8 (23.53%) stents showed low degree of restenosis, and 3 (8.83%) stents showed high degree of restenosis. In conclusion, we can accurately evaluate the degree of stenosis of lumen before and after coronary artery stent implantation with the application of 64-slice CTA.
Adult ; Aged ; Angioplasty, Balloon, Coronary ; Coronary Angiography ; methods ; Coronary Artery Disease ; diagnostic imaging ; therapy ; Coronary Restenosis ; diagnosis ; diagnostic imaging ; Female ; Humans ; Male ; Middle Aged ; Retrospective Studies ; Sensitivity and Specificity ; Stents ; Tomography, Spiral Computed ; methods

BACKGROUNDIn-stent restenosis (ISR) has become one of the most challenging problems in patients with coronary heart disease. At present, using non-invasive methods to assess ISR is a hot topic. In this investigation we attempted to explore the potential of magnetocardiography (MCG) in diagnosis of in-stent restenosis.

METHODSMCG was analyzed in 52 patients with coronary artery disease for three times: before stenting, one month and 7 months after successful intracoronary stenting.

RESULTSThe average classification of total maps (ACTM) and the ratio of abnormal maps (RAM) were lower in 1 month after intracoronary stenting compared with that obtained before stent planting (2.91 vs 2.52, 65.74% vs 42.80%, P < 0.01), while complex ventricular excitation index (CVEI) increased from -42.63 to -20.05 (P < 0.01). In ISR subgroup (n = 16), RAM decreased in 1 month after intracoronary stenting compared to it before stenting (68.99% vs 45.26%, P < 0.05). ACTM increased in 7 months compared to that obtained in 1 month after stenting (3.15 vs 2.51, P < 0.05). According to the ROC curve, ACTM showed its unique diagnostic value in restenosis patients. The sensitivity and specificity of ACTM were 80.0%, 69.40%, respectively. Its positive predictive value and negative predictive value were 54.6% and 88.5%, respectively.

CONCLUSIONSAfter successful intracoronary stenting, most parameters of MCG were improved. ACTM was of prognostic value in diagnosing ISR.

Adult ; Aged ; Angioplasty, Balloon, Coronary ; Coronary Artery Disease ; diagnosis ; Coronary Restenosis ; diagnosis ; Female ; Humans ; Magnetocardiography ; methods ; Male ; Middle Aged ; Stents ; adverse effects

BACKGROUND AND OBJECTIVES: Metal allergy has been reported to be related to stent restenosis. Therefore, we sought to investigate the incidence of metal allergy with new carbon stent with ion implantation technique and its relationship to restenosis. SUBJECTS AND METHODS: Between April 2002 and June 2004, 128 patients (100 male, mean age 60+/-10 years) were included in this study. The clinical diagnoses of the study patients included 64 acute myocardial infarction, 24 unstable angina and 40 stable angina patients. Patients were randomly assigned to receive either an Arthos Inert Stent (the study group) or an Arthos stent (the control group), with follow-up angiography scheduled 6 months later. Three months after stent implantation, skin patch tests, for the detection of metal allergies, were performed with manganese, molybdenum, nickel and chromium. RESULTS: There were no differences between the age, genders, risk factors and multi-vessel involvement between the two groups, as well as no differences in the angiographic parameters and restenosis (p>0.05). There were no differences in the positive rates of the skin tests between the Arthos stent and Arthos Inert stent groups or between the restenosis and no-restenosis groups (p>0.05). CONSLUSION: The new carbon stent, with ion implantation, did not reduce coronary restenosis. An allergic reaction was not related to the stent technology or stent restenosis.
Angina, Stable ; Angina, Unstable ; Angiography ; Carbon* ; Chromium ; Coronary Artery Disease ; Coronary Restenosis ; Diagnosis ; Follow-Up Studies ; Humans ; Hypersensitivity* ; Incidence ; Male ; Manganese ; Molybdenum ; Myocardial Infarction ; Nickel ; Patch Tests ; Risk Factors ; Skin ; Skin Tests ; Stents*

OBJECTIVETo investigate the correlation of blood-stasis syndrome (BSS) and its accompanied syndromes with pathological changes showed in coronary angiography and restenosis after percutaneous coronary intervention (PCI).

METHODSA total of 335 coronary heart disease patients after successful PCI were randomized into the treated group treated with Xiongshao Capsule (XC) and the control group treated with placebo for 6 months. BSS score was evaluated before and 6 months after PCI, and coronary angiography was followed up 6 months after the operation to perform the correlation analysis on BSS and its accompanied syndromes with types and complexity of coronary lesion, and the Logistic multivariate stepwise regression analysis (LMSRA) on the influencing factors of restenosis.

RESULTSThere were 334 cases with complete angiographic data, of which 308 cases (91.9%) finished the study, and among them 147 cases received a follow-up with angiography. Correlation analysis showed that the BSS score was significantly correlated to the maximal stenosis degree and coronary lesion score demonstrated by coronary angiography before PCI (P < 0.01), and the correlation was accentuated along with the increasing of the patients' age and the course of disease. Among the accompanied syndromes, the yang-deficiency syndrome was significantly correlated to the complexity of coronary lesions and the degree of stenosis, while the turbid- phlegm syndrome was correlated with calcification of the lesions. The difference of BSS score before and after treatment in the treated group was significantly higher than that in the control group. LMSRA showed that the recurrence of angina and BSS score were the important influencing factors on the occurrence of coronary restenosis after PCI. The incidence of restenosis was not correlated to the accompanied syndromes, and also showed no significant difference among patients with different syndrome types.

CONCLUSIONThere is a certain correlation between BSS and the complexity of coronary lesions. The lesion is more severe in patients accompanied with yang-deficiency syndrome. The severity of BSS was an important influencing factor on the occurrence of restenosis after PCI, but no significant correlation was found between the occurrence and the type of accompanied syndromes.

Adult ; Aged ; Angioplasty, Balloon, Coronary ; Coronary Angiography ; Coronary Disease ; diagnostic imaging ; therapy ; Coronary Restenosis ; diagnostic imaging ; prevention & control ; Diagnosis, Differential ; Double-Blind Method ; Drugs, Chinese Herbal ; therapeutic use ; Female ; Humans ; Logistic Models ; Male ; Medicine, Chinese Traditional ; Middle Aged ; Phytotherapy