R. Mehran et al., Angiographic patterns of in-stent restenosis - Classification and implications for long-term outcome, CIRCULATION, 100(18), 1999, pp. 1872-1878
Citations number
31
Categorie Soggetti
Cardiovascular & Respiratory Systems","Cardiovascular & Hematology Research
Background-The angiographic presentation of in-stent restenosis (ISR) may c
onvey prognostic information on subsequent target vessel revascularizations
(TLR).
Methods and Results-We developed an angiographic classification of ISR acco
rding to the geographic distribution of intimal hyperplasia in reference to
the implanted stent. Pattern I includes focal (less than or equal to 10 mm
in length) lesions, pattern II is ISR>10 mm within the stent, pattern III
includes ISR>10 mm extending outside the stent, and pattern IV is totally o
ccluded ISR. We classified a total of 288 ISR lesions in 245 patients and v
erified the angiographic accuracy of the classification by intravascular ul
trasound. Pattern I was found in 42% of patients, pattern II in 21%, patter
n III in 30%, and pattern IV in 7%. Previously recurrent ISR was more frequ
ent with increasing grades of classification (9%, 20%, 34%, and 50% for cla
sses I to IV, respectively; P = 0.0001), as was diabetes (28%, 32%, 39%, an
d 48% in classes I to IV, respectively; P < 0.01), Angioplasty and stenting
were used predominantly in classes I and II, whereas classes III and IV we
re treated with atheroablation. Final diameter stenosis ranged between 21%
and 28% (P = NS among ISR patterns). TLR increased with increasing ISR clas
s; it was 19%, 35%, 50%, and 83% in classes I to IV, respectively (P < 0.00
1). Multivariate analysis showed that diabetes (odds ratio, 2.8), previousl
y recurrent ISR (odds ratio, 2.7), and ISR class (odds ratio, 1.7) were ind
ependent predictors of TLR.
Conclusions-The introduced angiographic classification is prognostically im
portant, and it may be used for appropriate and early patient triage for cl
inical and investigational purposes.