PCI complications: restenosis

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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
    • Ia : Restenosis within the stent
    • Ib : Restenosis at the edge of the stent
    • Ic : Restenosis at the articulation or gap
    • Id : Restenosis multifocal
  • 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. 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. 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. PMID 15596568. doi:10.1161/01.CIR.0000150331.14687.4B. 
  3. 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. PMID 12719283. doi:10.1161/01.CIR.0000070592.04766.36. 
  4. 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. PMID 12860901. doi:10.1161/01.CIR.0000083366.33686.11. 



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