ANGIOGRAPHIC AND INTRAVASCULAR ULTRASOUND PREDICTORS OF IN-STENT RESTENOSIS

Objectives. This study was performed to determine predictors of in-ste nt 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 t o be an important clinical problem. Methods. Between April 1993 and Ma rch 1997, 1,706 patients with 2,343 lesions were treated with a variet y of intracoronary stents. The majority of stents were placed with hig h pressure balloon inflations and intravascular ultrasound (IVUS) guid ance. Angiographic follow-up was obtained in 1,173 patients with 1,633 lesions (70%). Clinical, angiographic and IVUS variables were prospec tively recorded and analyzed by univariate and multivar late models fo r the ability to predict the occurrence of in stent restenosis defined as a diameter stenosis greater than or equal to 50%. Results. In-sten t restenosis was angiographically documented in 282 patients with 409 lesions (25%). The restenosis group had a significantly longer total s tent length, smaller reference lumen diameter, smaller final minimal l umen diameter (MLD) by angiography and smaller stent lumen cross-secti onal 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 ste nt length, smaller reference lumen diameter and smaller final MLD were strong predictors of in-stent restenosis, In lesions with IVUS guidan ce, IVUS stent lumen CSA was a better independent predictor than the a ngiographic measurements. Conclusions. Achieving an optimal stent lume n CSA by using IVUS guidance during the procedure and minimizing the t otal stent length may reduce in stent restenosis. (J Am Coll Cardiol 1 998;32:1630-5) (C)1998 by the American College of Cardiology.