Korean Circ J.  2007 Mar;37(3):97-102. 10.4070/kcj.2007.37.3.97.

Predictive Factors for Restenosis after Drug-Eluting Stent Implantation

• Lee CW
• Park SJ

• KMID: 2227079
• DOI: http://doi.org/10.4070/kcj.2007.37.3.97

Abstract

BACKGROUND AND OBJECTIVES: Despite the dramatic reduction in restenosis conferred by drug-eluting stents (DES), restenosis remains a significant problem for real-world patients. Restenosis is a complex phenomenon, and a variety of stent-, drug-, patient- and lesion-related factors have been studied as the determinants of restenosis after DES implantation.
METHODS
AND RESULTS: The stent delivery system, the polymer and the drug are integral components of DES, and these are the device-specific factors that can affect restenosis. While the sirolimuseluting Cypher stent appears to provide better outcomes than the paclitaxel-eluting Taxus stent in high-risk patient groups with complex lesions, such differences between the two DES are not apparent in the low-risk groups. Diabetic patients are generally prone to restenosis after percutaneous coronary intervention, but there are conflicting findings regarding the impact of diabetes mellitus on restenosis after DES implantation. The post-intervention final lumen area continues to be the most important determinant of restenosis after DES implantation, indicating that a greater stented area contributes to a decreased rate of restenosis even in the DES era. Non-uniform strut distribution and stent fracture also contribute to the development of restenosis after DES implantation. In addition, the risk of restenosis increases linearly according to lesion length, and a "full metal jacket" approach in small vessels is related to a high risk of DES failure.
CONCLUSION
Small vessel disease, diffuse disease and the type of DES are important predictors of restenosis after DES implantation. However, predicting restenosis remains difficult, and this indicates the need for further studies in order to ultimately identify those patients who are at high risk for DES failure.

Keyword

Stents; Risk factors; Coronary restenosis

MeSH Terms

Coronary Restenosis
Diabetes Mellitus
Drug-Eluting Stents*
Humans
Percutaneous Coronary Intervention
Polymers
Risk Factors
Stents
Taxus
Polymers

Figure

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  Fig. 1 Late lumen loss at follow-up for 1,062 lesions after bare-metal stents implantation.

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  Fig. 2 Frequency distribution of the late loss values for the Cypher and Taxus stents.

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  Fig. 3 The sensitivity and specificity curves identified the optimal cutoff values of the final minimum stent CSA (A) & stent length (B) that predicted angiographic restenosis after Cypher implantation. CSA: cross sectional area.

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  Fig. 4 Effects of lesion length on the restenosis rate in small coronary arteries (≤2.8 mm).

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