Sirolimus-eluting stent for treatment of complex in-stent restenosis
The first clinical experience
Muzaffer Degertekin, MD*,
Evelyn Regar, MD*,
Kengo Tanabe, MD*,
Pieter C. Smits, MD, PhD*,
Willem J. van der Giessen, MD, PhD, FACC*,
Stephan G. Carlier, MD, PhD*,
Pim de Feyter, MD, PhD, FACC*,
Jeroen Vos, MD, PhD*,
David P. Foley, MD, PhD, FACC*,
Jurgen M. R. Ligthart, MSc*,
Jeffrey J. Popma, MD, FACC and
Patrick W. Serruys, MD, PhD, FACC*,*
* Thoraxcenter, University Hospital Rotterdam, Rotterdam, The Netherlands
Brigham and Women’s Hospital, Boston, Massachusetts, USA
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Figure 1 A chronically occluded left circumflex due to in-stent restenosis (PRE) was treated with a sirolimus eluting stent (POST). Follow-up (FU) angiography showed no restenosis; intravascular ultrasound (IVUS) revealed no neointimal hyperplasia with the clear appearance of double stent struts. * indicates the position of the IVUS catheter.
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Figure 2 (A) Angiograms: the long proliferative in-stent restonsis (ISR) (PRE) was treated with two sirolimus eluting stents (SESs) (POST). The follow-up angiogram showed focal-repeat ISR (62% DS) in the gap (arrow), which was not covered by the SES. No neointimal hyperplasia (NIH) was evident in the two SESs (A and C). (B) Intravascular ultrasound (IVUS): follow-up IVUS showed no NIH in the proximal (A) and distal (C) SES with images of two layers of stent struts. Neointimal hyperplasia was noted in the gap region (B) where only one layer of (bare) stent struts can be seen. *indicates the position of the IVUS catheter at the gap segment.
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