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CLINICAL STUDIES

Angiographic and intravascular ultrasound predictors of in-stent restenosis

^a University of California, Irvine, California, USA
^* Centro Cuore Columbus, Milan, Italy

Manuscript received January 26, 1998; revised manuscript received July 7, 1998, accepted July 24, 1998.

Address for correspondence: Dr. Jonathan M. Tobis, Department of Medicine, Division of Cardiology, University of California at Irvine, 101 City Drive South, Building 53, Route 81, Room 100, Orange, California 92868-3298
jmtobis{at}uci.edu

Objectives. This study was performed to determine predictors of in-stent restenosis from a high volume, single-center practice.

Background. Intracoronary stents have been shown to reduce the restenosis rate as compared with balloon angioplasty, but in-stent restenosis continues to be an important clinical problem.

Methods. Between April 1993 and March 1997, 1,706 patients with 2,343 lesions were treated with a variety of intracoronary stents. The majority of stents were placed with high pressure balloon inflations and intravascular ultrasound (IVUS) guidance. Angiographic follow-up was obtained in 1,173 patients with 1,633 lesions (70%). Clinical, angiographic and IVUS variables were prospectively recorded and analyzed by univariate and multivariate models for the ability to predict the occurrence of in-stent restenosis defined as a diameter stenosis 50%.

Results. In-stent restenosis was angiographically documented in 282 patients with 409 lesions (25%). The restenosis group had a significantly longer total stent length, smaller reference lumen diameter, smaller final minimal lumen diameter (MLD) by angiography and smaller stent lumen cross-sectional area (CSA) by IVUS. In lesions where IVUS guidance was used, the restenosis rate was 24% as compared with 29% if IVUS was not used (p < 0.05). By multivariate logistic regression analysis, longer total stent length, smaller reference lumen diameter and smaller final MLD were strong predictors of in-stent restenosis. In lesions with IVUS guidance, IVUS stent lumen CSA was a better independent predictor than the angiographic measurements.

Conclusions. Achieving an optimal stent lumen CSA by using IVUS guidance during the procedure and minimizing the total stent length may reduce in-stent restenosis.

Abbreviations and Acronyms   CSA = cross-sectional area   %DS = percent diameter stenosis   IVUS = intravascular ultrasound   MLD = minimal lumen diameter   OR = odds ratio

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