AS-173: Intravascular Ultrasound Risk Factors for Repeat Target Lesion Revascularization After Treatment of Restenosis

Wednesday, April 28 - Friday, April 30, 2010 (E-Poster Abstract Zone) stents, 27 sirolimus-eluting stents, 28 zotarolimus-eluting stents, and 9 other DES). We compared the VH-IVUS parameters between 19 in-stent restenosis (ISR) lesions and 110 non-ISR lesions. VHIVUS classified the color-coded tissue into 4 major components: fibrotic (FT), fibro-fatty (FF), dense calcium (DC), and necrotic core (NC). Results: The ISR group had more patients with diabetes mellitus (50% vs 33%, p ⫽ 0.050) and higher glucose levels compared with the non-ISR group (173 ⫾ 57 mg/dL vs 143 ⫾ 40 mg/dL, p ⫽ 0.036) (for glucose, 1 mg/dL ⫽ 0.0555 mmol/L). There were no significant differences in target vessel and American College of Cardiology/American Heart Association lesion type between the ISR and non-ISR groups. There were no significant differences in lesion site external elastic membrane (13.9 ⫾ 3.1 mm2 vs 14.7 ⫾ 5.5 mm2) and plaque plus media areas (3.9 ⫾ 0.7 mm2 vs 4.0 ⫾ 1.4 mm2) between the ISR and non-ISR groups. There were no significant differences in relative plaque components at the minimum lumen site (FT, 56.7 ⫾ 16.8% vs 59.0 ⫾ 13.7%; FF, 6.3 ⫾ 5.1% vs 11.5 ⫾ 9.8%; DC, 13.3 ⫾ 9.9% vs 9.3 ⫾ 8.3%; and NC, 23.7 ⫾ 12.9% vs 20.1 ⫾ 11.9%) and relative volumetric plaque components (FT, 57.5 ⫾ 11.9% vs 58.7 ⫾ 10.9%; FF, 10.1 ⫾ 6.4% vs 12.0 ⫾ 8.1%; DC, 12.4 ⫾ 6.8% vs 10.9 ⫾ 6.8%; NC, 20.3 ⫾ 10.6% vs 18.5 ⫾ 9.4%) between the ISR and non-ISR groups. There were no correlations between follow-up percent (%) neointima volume and volumetric plaque components (%FT: r ⫽ ⫺0.002, p ⫽ 0.990; %FF: r ⫽ 0.187, p ⫽ 0.175; %DC: r ⫽ ⫺0.014, p ⫽ 0.920; and %NC: r ⫽ ⫺0.123, p ⫽ 0.376). Conclusion: There was no relation between plaque components assessed by VH-IVUS and neointimal hyperplasia after DES implantation. Plaque components may affect plaque vulnerability at the initial clinical presentation, but not long-term clinical outcome.

AS-173

Conclusion: CBA for focal DES restenosis resulted in a favorable clinical outcome. Larger plaque burden outside of the stent and edge location of restenosis was associated with re-TLR.

AS-174

Intravascular Ultrasound Risk Factors for Repeat Target Lesion Revascularization After Treatment of Restenosis. Seung Jin Oh, Yong Seon Moon, Se-Jung Yoon, Byeong-Keuk Kim, Dong Woon Jeon, Joo Young Yang. NHIC Ilsan Hospital, Goyang, Republic of Korea.

Ischemic-Driven Late Target Lesion Revascularization Due to “Catch-Up” Phenomenon After Implantation of Drug-Eluting Stents. Hun-Jun Park, Ki-Bae Seung. Seoul St. Mary’s Hospital, Seoul, Republic of Korea.

Background: There are limited data about outcomes after treatment of drug-eluting stent (DES) restenosis. This study evaluated the intravascular ultrasound risk factors for repeat target lesion revascularization (re-TLR) after treatment of DES restenosis. Methods: A total of 40 lesions that underwent TLR for focal DES restenosis with cutting balloon angioplasty (CBA) were included in this study. The lesions were divided according to the occurrence of re-TLR (re-TLR vs no re-TLR). Intravascular ultrasound examination was performed before and after intervention with CBA. We measured the vessel, lumen, and stent area at the site of minimum lumen area and calculated the plaque and neointima area. Clinical and angiographic variables were also gathered. Results: A total of 6 cases of re-TLR occurred (15%). Clinical variables were comparable between groups. Types of DES and lesion location were also comparable between groups. Restenosis length was not different between groups (7.09 ⫾ 3.49 mm vs 9.16 ⫾ 7.49 mm, p ⫽ not significant). Edge location (within 5 mm from stent edge) of restenosis was more frequently seen with the re-TLR group (66.7% vs 17.6%, p ⬍0.05). The re-TLR group showed significantly greater vessel and plaque area compared with the no re-TLR group. Neither the baseline neointima area nor final lumen area were not different between groups (Table).

Background: Concerns have been raised about the “late catch-up” (LCU) phenomenon in the drug-eluting stent (DES) era. This study sought to assess clinical, laboratory, and angiographic characteristics in patients developing ischemic-driven target lesion revascularization (TLR) due to the LCU phenomenon after DES implantation. Methods: Of 674 patients undergoing DES stenting, 334 (49.5%) patients had 6- to 8-month angiographic follow-up and were enrolled in the study. Results: TLR was performed in 8 patients; these patients were not considered for further analysis. Of the 326 remaining patients, 87 (26.7%) patients received ischemic-driven follow-up coronary angiography (CAG) (median duration, 22.7 months; range, 12.8 – 60.5 months). A total of 25 (7.7%) patients underwent non-TLR because of the progression of de novo lesions and 21 (6.4%) patients underwent ischemic-driven TLR due to LCU phenomenon, which was defined as: (1) newly developed ischemic symptoms and/or evidence of myocardial ischemia on stress tests after routine follow-up CAG, and (2) significant restenosis (percent diameter stenosis ⱖ70%) in the target lesion on ischemic-driven follow-up CAG. In the LCU group, 16 (76.2%) were sirolimus-eluting stents and 4 (23.8%) were paclitaxeleluting stents. In patterns of neointimal growth, 14 of 21 (66.7%) were focal and 11 of 14 (78.6%) were in-segment restenosis. In the ANOVA test, baseline serum creatinine (1.87 mg/dL vs 0.94 mg/dL, p ⫽ 0.053)

The American Journal of Cardiology姞 APRIL 28 –30 2010 ANGIOPLASTY SUMMIT ABSTRACTS/E-Poster 73B

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