Vascular responses to the multiple overlapped paclitaxel-eluting stents for the treatment of bare-metal in-stent restenotic lesions: angiographic and intravascular ultrasound analysis from the TAXUS-V ISR Trial

Koizumi, Tomomi; Fitzgerald, Peter J.; Honda, Yasuhiro; Ellis, Stephen G.; Kent, Kenneth; Martin, Steven L.; Brown, Charles L.; Masud, A.R. Zaki; Patterson, John B.; Greenberg, Joel; Friedman, Mark; Uchida, Takahiro; Stone, Gregg W.

doi:10.1016/j.carrev.2009.07.004

« Previous Next »Cardiovascular Revascularization Medicine
Volume 11, Issue 3 , Pages 140-148, July 2010

Vascular responses to the multiple overlapped paclitaxel-eluting stents for the treatment of bare-metal in-stent restenotic lesions: angiographic and intravascular ultrasound analysis from the TAXUS-V ISR Trial

Tomomi Koizumi
- Stanford University, Stanford, CA, USA
Peter J. Fitzgerald
- Stanford University, Stanford, CA, USA
- Corresponding author. Center for Cardiovascular Technology, Stanford University 300 Pasteur Drive, Rm H3554, Stanford, CA 94305-5637, USA. Tel.: +1 650 498 6034; fax: +1 650 498 6027.
Yasuhiro Honda
- Stanford University, Stanford, CA, USA
Stephen G. Ellis
- Cleveland Clinic Foundation, Cleveland, OH, USA
Kenneth Kent
- Washington Cardiology Center, Washington, DC, USA
Steven L. Martin
- Nebraska Heart Institute, Lincoln, NE, USA
Charles L. Brown
- Piedmont Hospital, Atlanta, GA, USA
A.R. Zaki Masud
- Buffalo General Hospital, Buffalo, NY, USA
John B. Patterson
- Forsyth Medical Center, Winston-Salem, NC
Joel Greenberg
- Florida Heart Institute, Orlando, FL, USA
Mark Friedman
- Boston Scientific Corporation, Natick, MA, USA
Takahiro Uchida
- Boston Scientific Corporation, Natick, MA, USA
Gregg W. Stone
- Columbia University Medical Center/Cardiovascular Research Foundation, New York, NY

Received 28 June 2009; accepted 8 July 2009.

Abstract

Background

Although effective coverage of coronary diffuse in-stent restenosis (ISR) lesions has warranted the use of multiple drug-eluting stents, the vessel response to paclitaxel-eluting stent (PES) overlap is not fully understood.

Methods and materials

In the TAXUS-V ISR, i.e., comparing PES versus brachytherapy for the treatment of bare-metal ISR, angiographic analyses at 9-month follow-up were available in 184 ISR lesions treated with PES.

Results

In-stent late loss in entire stented segment of multiple PES (n=50) was 0.45±0.48 mm, whereas that of single PES (n=134) was 0.3±0.47 mm, P=.06. No aneurysm was observed at overlapping PES segments at 9 months. Stent thrombosis up to 9 months was observed in one in each group (single PES, 0.7% vs. multiple PES, 1.8%; P=.47). In a subset of 30 patients, volumetric intravascular ultrasound analysis demonstrated that in-stent net volume obstruction was 12.3±12.4 in single PES (n=20) and 14.9±9.8 in multiple PES (n=10), P=.60. The changes of vessel and lumen at the overlapping PES segment were similar to those of the adjacent 5-mm segments (Δminimum lumen area, mm²: −1.2±1.0, −1.1±1.1, −0.8±0.9, P=.48; Δvessel volume, mm³/mm: −0.2±1.4, 0.1±1.7, 0.3±1.3, P=.37; proximal, overlap, distal segment, respectively). There was no late incomplete stent apposition at overlapping PES segments.