PCI complications: restenosis: Difference between revisions
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In the setting of in-[[stent]] restenosis (ISR) after [[bare metal stent|bare metal stent (BMS)]] implantation, the risk of recurrence can be predicted by the pattern of restenosis. | In the setting of in-[[stent]] restenosis (ISR) after [[bare metal stent|bare metal stent (BMS)]] implantation, the risk of recurrence can be predicted by the pattern of restenosis. | ||
===Classification=== | ===Classification=== | ||
''Table 1. Mehran Classification System | ''Table 1. Mehran Classification System<ref name="pmid10545431">{{cite journal| author=Mehran R, Dangas G, Abizaid AS, Mintz GS, Lansky AJ, Satler LF et al.| title=Angiographic patterns of in-stent restenosis: classification and implications for long-term outcome. | journal=Circulation | year= 1999 | volume= 100 | issue= 18 | pages= 1872-8 | pmid=10545431 | doi= | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=10545431 }} </ref>'' | ||
* Pattern I: Focal (≤ 10 mm in length) [[lesion]]s | * Pattern I: Focal (≤ 10 mm in length) [[lesion]]s | ||
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===Implications=== | ===Implications=== | ||
The need for recurrent target [[lesion]] [[revascularization]] (TLR) increased with increasing ISR class, increasing from 19%, 35%, 50%, to 83% in classes I to IV, respectively (P <0.001) | The need for recurrent target [[lesion]] [[revascularization]] (TLR) increased with increasing ISR class, increasing from 19%, 35%, 50%, to 83% in classes I to IV, respectively (P <0.001)<ref name="pmid10545431">{{cite journal| author=Mehran R, Dangas G, Abizaid AS, Mintz GS, Lansky AJ, Satler LF et al.| title=Angiographic patterns of in-stent restenosis: classification and implications for long-term outcome. | journal=Circulation | year= 1999 | volume= 100 | issue= 18 | pages= 1872-8 | pmid=10545431 | doi= | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=10545431 }} </ref>. | ||
Restenosis after [[DES|drug eluting stent]] implantation is generally more focal than following [[bare metal stent]] placement | Restenosis after [[DES|drug eluting stent]] implantation is generally more focal than following [[bare metal stent]] placement<ref name="pmid15596568">{{cite journal| author=Popma JJ, Leon MB, Moses JW, Holmes DR, Cox N, Fitzpatrick M et al.| title=Quantitative assessment of angiographic restenosis after sirolimus-eluting stent implantation in native coronary arteries. | journal=Circulation | year= 2004 | volume= 110 | issue= 25 | pages= 3773-80 | pmid=15596568 | doi=10.1161/01.CIR.0000150331.14687.4B | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=15596568 }} </ref><ref name="pmid12719283">{{cite journal| author=Colombo A, Orlic D, Stankovic G, Corvaja N, Spanos V, Montorfano M et al.| title=Preliminary observations regarding angiographic pattern of restenosis after rapamycin-eluting stent implantation. | journal=Circulation | year= 2003 | volume= 107 | issue= 17 | pages= 2178-80 | pmid=12719283 | doi=10.1161/01.CIR.0000070592.04766.36 | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=12719283 }} </ref>, and, with the [[sirolimus eluting stent]], more is commonly at the margin of the [[stent]] due to [[balloon]] injury that is not covered with [[stent]]<ref name="pmid15596568">{{cite journal| author=Popma JJ, Leon MB, Moses JW, Holmes DR, Cox N, Fitzpatrick M et al.| title=Quantitative assessment of angiographic restenosis after sirolimus-eluting stent implantation in native coronary arteries. | journal=Circulation | year= 2004 | volume= 110 | issue= 25 | pages= 3773-80 | pmid=15596568 | doi=10.1161/01.CIR.0000150331.14687.4B | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=15596568 }} </ref><ref name="pmid12719283">{{cite journal| author=Colombo A, Orlic D, Stankovic G, Corvaja N, Spanos V, Montorfano M et al.| title=Preliminary observations regarding angiographic pattern of restenosis after rapamycin-eluting stent implantation. | journal=Circulation | year= 2003 | volume= 107 | issue= 17 | pages= 2178-80 | pmid=12719283 | doi=10.1161/01.CIR.0000070592.04766.36 | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=12719283 }} </ref><ref name="pmid12860901">{{cite journal| author=Lemos PA, Saia F, Ligthart JM, Arampatzis CA, Sianos G, Tanabe K et al.| title=Coronary restenosis after sirolimus-eluting stent implantation: morphological description and mechanistic analysis from a consecutive series of cases. | journal=Circulation | year= 2003 | volume= 108 | issue= 3 | pages= 257-60 | pmid=12860901 | doi=10.1161/01.CIR.0000083366.33686.11 | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=12860901 }} </ref>. | ||
==References== | ==References== | ||
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{{WH}} | {{WH}} | ||
{{WS}} | {{WS}} | ||
[[Category:Needs overview]] | [[Category:Needs overview]] | ||
[[Category:Cardiology]] | [[Category:Cardiology]] | ||
Revision as of 20:36, 18 January 2013
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Editors-In-Chief: Alexandra Almonacid M.D.; Jeffrey J. Popma M.D.
Restenosis
In the setting of in-stent restenosis (ISR) after bare metal stent (BMS) implantation, the risk of recurrence can be predicted by the pattern of restenosis.
Classification
Table 1. Mehran Classification System[1]
- Pattern I: Focal (≤ 10 mm in length) lesions
- Pattern II: ISR >10 mm within the stent
- Pattern III: Includes ISR > 10 mm extending outside the stent
- Pattern IV: ISR totally occluded
Implications
The need for recurrent target lesion revascularization (TLR) increased with increasing ISR class, increasing from 19%, 35%, 50%, to 83% in classes I to IV, respectively (P <0.001)[1].
Restenosis after drug eluting stent implantation is generally more focal than following bare metal stent placement[2][3], and, with the sirolimus eluting stent, more is commonly at the margin of the stent due to balloon injury that is not covered with stent[2][3][4].
References
- ↑ 1.0 1.1 Mehran R, Dangas G, Abizaid AS, Mintz GS, Lansky AJ, Satler LF; et al. (1999). "Angiographic patterns of in-stent restenosis: classification and implications for long-term outcome". Circulation. 100 (18): 1872–8. PMID 10545431.
- ↑ 2.0 2.1 Popma JJ, Leon MB, Moses JW, Holmes DR, Cox N, Fitzpatrick M; et al. (2004). "Quantitative assessment of angiographic restenosis after sirolimus-eluting stent implantation in native coronary arteries". Circulation. 110 (25): 3773–80. doi:10.1161/01.CIR.0000150331.14687.4B. PMID 15596568.
- ↑ 3.0 3.1 Colombo A, Orlic D, Stankovic G, Corvaja N, Spanos V, Montorfano M; et al. (2003). "Preliminary observations regarding angiographic pattern of restenosis after rapamycin-eluting stent implantation". Circulation. 107 (17): 2178–80. doi:10.1161/01.CIR.0000070592.04766.36. PMID 12719283.
- ↑ Lemos PA, Saia F, Ligthart JM, Arampatzis CA, Sianos G, Tanabe K; et al. (2003). "Coronary restenosis after sirolimus-eluting stent implantation: morphological description and mechanistic analysis from a consecutive series of cases". Circulation. 108 (3): 257–60. doi:10.1161/01.CIR.0000083366.33686.11. PMID 12860901.