This Article Figures Only Full Text Full Text (PDF) Alert me when this article is cited Alert me if a correction is posted Services Email this article to a friend Similar articles in this journal Similar articles in Web of Science Similar articles in PubMed Alert me to new issues of the journal Download to citation manager Citing Articles Citing Articles via HighWire Citing Articles via Web of Science (65) Citing Articles via Google Scholar Google Scholar Articles by Ako, J. Articles by Fitzgerald, P. J. Search for Related Content PubMed PubMed Citation Articles by Ako, J. Articles by Fitzgerald, P. J.

CLINICAL RESEARCH: INTERVENTIONAL CARDIOLOGY

Late Incomplete Stent Apposition After Sirolimus-Eluting Stent Implantation

A Serial Intravascular Ultrasound Analysis

Junya Ako, MD^_*, Yoshihiro Morino, MD^_*, Yasuhiro Honda, MD, FACC^_*, Ali Hassan, MD^_*, Shinjo Sonoda, MD, PhD^_*, Paul G. Yock, MD, FACC^_*, Martin B. Leon, MD, FACC, Jeffrey W. Moses, MD, FACC, Heidi N. Bonneau, RN, MS and Peter J. Fitzgerald, MD, PhD, FACC^_*,_*

^_* Center for Research in Cardiovascular Interventions, Stanford University Medical Center, Stanford, California
Lenox Hill Hospital, New York, New York
Highlands Consulting Inc., San Jose, California.

Manuscript received August 16, 2004; revised manuscript received May 25, 2005, accepted May 31, 2005.

^_* Reprint requests and correspondence: Dr. Peter J. Fitzgerald, Center for Research in Cardiovascular Interventions, Stanford University Medical Center, 300 Pasteur Drive, H3554, Stanford, California 94305-5637. (Email: ivus{at}crci.stanford.edu).

OBJECTIVES: We sought to identify the frequency of incomplete stent apposition (ISA) in sirolimus-eluting stents (SES) and clarify its findings and clinical sequelae.

BACKGROUND: Late-acquired ISA has been reported in bare-metal stents (BMS) and brachytherapy and recently in drug-eluting stents. However, the characteristics of late ISA in SES have not been clarified.

METHODS: From the SIRIUS trial, a randomized, multicenter study comparing SES and BMS, serial qualitative intravascular ultrasound (IVUS; at stent implantation and eight-month follow-up) was available in 141 patients (BMS: n = 61; SES: n = 80). The IVUS images were reviewed for the presence of ISA.

RESULTS: Incomplete stent apposition at follow-up was observed in 19 patients (BMS: n = 6 [9.8%]; SES: n = 13 [16.3%]; p = NS). Among these, 12 had ISA after intervention and at follow-up (persistent ISA). Late-acquired ISA was seen in the remaining seven cases, all from the SES group (BMS: n = 0; SES: n = 7 [8.7%]; p < 0.05). In late-acquired ISA, there was an increase in external elastic membrane area (after intervention: 16.2 ± 2.7 m²; follow-up: 18.9 ± 3.6 mm²; p < 0.05). The location of stent-vessel wall separation was primarily at the stent edges in persistent ISA cases, whereas late-acquired ISA in SES occurred mostly in the mid portion of the stent. There were no negative clinical events reported for any ISA cases at 12-month clinical follow-up.

CONCLUSIONS: Late ISA was observed in 8.7% of patients after SES implantation. There were no negative clinical events associated with this IVUS finding at 12-month clinical follow-up; however, careful long-term follow-up will be necessary.

Abbreviations and Acronyms   BMS = bare-metal stent   DES = drug-eluting stent   EEM = external elastic membrane   ISA = incomplete stent apposition   IVUS = intravascular ultrasound   SES = sirolimus-eluting stent   SIRIUS = Sirolimus-Eluting Stent in De Novo Coronary Lesions study

This article has been cited by other articles:

				A. Maehara, G. S. Mintz, A. J. Lansky, B. Witzenbichler, G. Guagliumi, B. Brodie, M. A. Kellett Jr, H. Parise, R. Mehran, and G. W. Stone Volumetric Intravascular Ultrasound Analysis of Paclitaxel-Eluting and Bare Metal Stents in Acute Myocardial Infarction: The Harmonizing Outcomes With Revascularization and Stents in Acute Myocardial Infarction Intravascular Ultrasound Substudy Circulation, November 10, 2009; 120(19): 1875 - 1882. [Abstract] [Full Text] [PDF]

				F. Sera, M. Awata, M. Uematsu, J.-i. Kotani, S. Nanto, and S. Nagata Optimal Stent-Sizing With Intravascular Ultrasound Contributes to Complete Neointimal Coverage After Sirolimus-Eluting Stent Implantation Assessed by Angioscopy J. Am. Coll. Cardiol. Intv., October 1, 2009; 2(10): 989 - 994. [Abstract] [Full Text] [PDF]

				K. Waseda, A. Miyazawa, J. Ako, T. Hasegawa, I. Tsujino, R. Sakurai, P. G. Yock, Y. Honda, D. E. Kandzari, M. B. Leon, et al. Intravascular Ultrasound Results From the ENDEAVOR IV Trial: Randomized Comparison Between Zotarolimus- and Paclitaxel-Eluting Stents in Patients With Coronary Artery Disease J. Am. Coll. Cardiol. Intv., August 1, 2009; 2(8): 779 - 784. [Abstract] [Full Text] [PDF]

				F. Alfonso, M.-J. Perez-Vizcayno, M. Ruiz, A. Suarez, M. Cazares, R. Hernandez, J. Escaned, C. Banuelos, P. Jimenez-Quevedo, and C. Macaya Coronary aneurysms after drug-eluting stent implantation clinical, angiographic, and intravascular ultrasound findings. J. Am. Coll. Cardiol., June 2, 2009; 53(22): 2053 - 2060. [Abstract] [Full Text] [PDF]

				S. Verheye, P. Agostoni, K. D. Dawkins, J. Dens, W. Rutsch, D. Carrie, J. Schofer, C. Lotan, C. L. Dubois, S. A. Cohen, et al. The GENESIS (Randomized, Multicenter Study of the Pimecrolimus-Eluting and Pimecrolimus/Paclitaxel-Eluting Coronary Stent System in Patients with De Novo Lesions of the Native Coronary Arteries) Trial J. Am. Coll. Cardiol. Intv., March 1, 2009; 2(3): 205 - 214. [Abstract] [Full Text] [PDF]

				A. K.M. Hassan, S. C. Bergheanu, T. Stijnen, B. L. van der Hoeven, J. D. Snoep, J. W.M. Plevier, M. J. Schalij, and J. W. Jukema Late stent malapposition risk is higher after drug-eluting stent compared with bare-metal stent implantation and associates with late stent thrombosis Eur. Heart J., January 21, 2009; (2009) ehn553v1. [Abstract] [Full Text] [PDF]

				Y. Honda and P. J. Fitzgerald Frontiers in Intravascular Imaging Technologies Circulation, April 15, 2008; 117(15): 2024 - 2037. [Full Text] [PDF]

				B. L. van der Hoeven, S.-S. Liem, J. Dijkstra, S. C. Bergheanu, H. Putter, M. L. Antoni, D. E. Atsma, M. Bootsma, K. Zeppenfeld, J. W. Jukema, et al. Stent Malapposition After Sirolimus-Eluting and Bare-Metal Stent Implantation in Patients with ST-Segment Elevation Myocardial Infarction: Acute and 9-Month Intravascular Ultrasound Results of the MISSION! Intervention Study J. Am. Coll. Cardiol. Intv., April 1, 2008; 1(2): 192 - 201. [Abstract] [Full Text] [PDF]

				A. Colombo and A. Latib Late incomplete stent apposition after drug-eluting stent implantation: a true risk factor or "an innocent bystander"? Heart, March 1, 2008; 94(3): 253 - 254. [Full Text] [PDF]

				R Hoffmann, M-C Morice, J W Moses, P J Fitzgerald, L Mauri, G Breithardt, J Schofer, P W Serruys, H-P Stoll, and M B Leon Impact of late incomplete stent apposition after sirolimus-eluting stent implantation on 4-year clinical events: intravascular ultrasound analysis from the multicentre, randomised, RAVEL, E-SIRIUS and SIRIUS trials Heart, March 1, 2008; 94(3): 322 - 328. [Abstract] [Full Text] [PDF]

				B. L. van der Hoeven, S.-S. Liem, J. W. Jukema, N. Suraphakdee, H. Putter, J. Dijkstra, D. E. Atsma, M. Bootsma, K. Zeppenfeld, P. V. Oemrawsingh, et al. Sirolimus-eluting stents versus bare-metal stents in patients with ST-segment elevation myocardial infarction: 9-month angiographic and intravascular ultrasound results and 12-month clinical outcome results from the MISSION! Intervention Study. J. Am. Coll. Cardiol., February 12, 2008; 51(6): 618 - 626. [Abstract] [Full Text] [PDF]

				J. Aoki, A. Kirtane, M. B. Leon, and G. Dangas Coronary artery aneurysms after drug-eluting stent implantation. J. Am. Coll. Cardiol. Intv., February 1, 2008; 1(1): 14 - 21. [Abstract] [Full Text] [PDF]

				E. Romagnoli, G. M. Sangiorgi, J. Cosgrave, E. Guillet, and A. Colombo Drug-eluting stenting the case for post-dilation. J. Am. Coll. Cardiol. Intv., February 1, 2008; 1(1): 22 - 31. [Abstract] [Full Text] [PDF]

				B. Doyle, C. S. Rihal, C. J. O'Sullivan, R. J. Lennon, H. J. Wiste, M. Bell, J. Bresnahan, and D. R. Holmes Jr Outcomes of Stent Thrombosis and Restenosis During Extended Follow-Up of Patients Treated With Bare-Metal Coronary Stents Circulation, November 20, 2007; 116(21): 2391 - 2398. [Abstract] [Full Text] [PDF]

				S. Windecker and B. Meier Late Coronary Stent Thrombosis Circulation, October 23, 2007; 116(17): 1952 - 1965. [Full Text] [PDF]

				M.-K. Hong, G. S. Mintz, C. W. Lee, D.-W. Park, S.-W. Lee, Y.-H. Kim, D.-H. Kang, S.-S. Cheong, J.-K. Song, J.-J. Kim, et al. Impact of Late Drug-Eluting Stent Malapposition on 3-Year Clinical Events J. Am. Coll. Cardiol., October 9, 2007; 50(15): 1515 - 1516. [Full Text] [PDF]

				R. Jaffe and B. H. Strauss Late and Very Late Thrombosis of Drug-Eluting Stents: Evolving Concepts and Perspectives J. Am. Coll. Cardiol., July 10, 2007; 50(2): 119 - 127. [Abstract] [Full Text] [PDF]

				N. J. Weissman, S. G. Ellis, E. Grube, K. D. Dawkins, J. D. Greenberg, T. Mann, L. A. Cannon, P. A. Cambier, S. Fernandez, G. S. Mintz, et al. Effect of the polymer-based, paclitaxel-eluting TAXUS Express stent on vascular tissue responses: a volumetric intravascular ultrasound integrated analysis from the TAXUS IV, V, and VI trials Eur. Heart J., July 1, 2007; 28(13): 1574 - 1582. [Abstract] [Full Text] [PDF]

				D. A. Siqueira, A. A. Abizaid, J. d. R. Costa, F. Feres, L. A. Mattos, R. Staico, A. A. Abizaid, L. F. Tanajura, A. Chaves, M. Centemero, et al. Late incomplete apposition after drug-eluting stent implantation: incidence and potential for adverse clinical outcomes Eur. Heart J., June 1, 2007; 28(11): 1304 - 1309. [Abstract] [Full Text] [PDF]

				G. S. Mintz What to Do About Late Incomplete Stent Apposition? Circulation, May 8, 2007; 115(18): 2379 - 2381. [Full Text] [PDF]

				S. Cook, P. Wenaweser, M. Togni, M. Billinger, C. Morger, C. Seiler, R. Vogel, O. Hess, B. Meier, and S. Windecker Incomplete Stent Apposition and Very Late Stent Thrombosis After Drug-Eluting Stent Implantation Circulation, May 8, 2007; 115(18): 2426 - 2434. [Abstract] [Full Text] [PDF]

				D. Matsumoto, J. Shite, T. Shinke, H. Otake, Y. Tanino, D. Ogasawara, T. Sawada, O. L. Paredes, K.-i. Hirata, and M. Yokoyama Neointimal coverage of sirolimus-eluting stents at 6-month follow-up: evaluated by optical coherence tomography Eur. Heart J., April 2, 2007; 28(8): 961 - 967. [Abstract] [Full Text] [PDF]

				D. E. Kandzari, M. B. Leon, J. J. Popma, P. J. Fitzgerald, C. O'Shaughnessy, M. W. Ball, M. Turco, R. J. Applegate, P. A. Gurbel, M. G. Midei, et al. Comparison of Zotarolimus-Eluting and Sirolimus-Eluting Stents in Patients With Native Coronary Artery Disease: A Randomized Controlled Trial J. Am. Coll. Cardiol., December 19, 2006; 48(12): 2440 - 2447. [Abstract] [Full Text] [PDF]

				C. Kimmelstiel Multislice Computed Tomography After Left Main Drug-Eluting Stenting: Are We Putting the CarT Before the Horse? Circulation, August 15, 2006; 114(7): 616 - 619. [Full Text] [PDF]

				G. S. Mintz and N. J. Weissman Intravascular Ultrasound in the Drug-Eluting Stent Era J. Am. Coll. Cardiol., August 1, 2006; 48(3): 421 - 429. [Abstract] [Full Text] [PDF]

				P. Jimenez-Quevedo, M. Sabate, D. J. Angiolillo, M. A. Costa, F. Alfonso, J. A. Gomez-Hospital, R. Hernandez-Antolin, C. Banuelos, J. Goicolea, F. Fernandez-Aviles, et al. Vascular Effects of Sirolimus-Eluting Versus Bare-Metal Stents in Diabetic Patients: Three-Dimensional Ultrasound Results of the Diabetes and Sirolimus-Eluting Stent (DIABETES) Trial J. Am. Coll. Cardiol., June 6, 2006; 47(11): 2172 - 2179. [Abstract] [Full Text] [PDF]

				S. R. Dixon, C. L. Grines, and W. W. O'Neill The Year in Interventional Cardiology J. Am. Coll. Cardiol., April 18, 2006; 47(8): 1689 - 1706. [Full Text] [PDF]