Predictors of diffuse and aggressive intra-stent restenosis

OBJECTIVES This study was performed to investigate the causes of diffuse an d aggressive intra-stent restenosis. BACKGROUND Although restenosis is usually considered to be a dichotomous va riable, there is clinical relevance to the severity of restenosis. It is no t known which variables are predictive of diffuse or aggressive intra-stent restenosis. METHODS A consecutive series of 456 coronary lesions with in-stent restenos is was evaluated for the type of restenosis using quantitative coronary ang iography. Restenosis was defined as greater than or equal to 50% diameter s tenosis at follow-up angiography, diffuse restenosis as a follow-up lesion length greater than or equal to 10 mm and aggressive restenosis as either a il increase in lesion length from the original lesion or a restenotic narro wing tighter than the original. Clinical, anatomic and procedural character istics were evaluated fur lesions associated with these types of restenosis . RESULTS Diffuse restenosis was associated with a smaller reference artery d iameter, longer lesion length, female gender, longer stent length and the u se of soil stents. Aggressive restenosis was more common in women, with the use of Wallstents and with long stent tu lesion length ratios. Aggressive restenosis occurred earlier and was more closely associated with symptoms a nd myocardial inflictions than nonaggressive restenotic lesions. CONCLUSIONS Markers for diffuse restenosis were also important markers for the presence of any restenosis. A long stent to lesion length ratio is an i mportant marker for aggressive restenosis. When severe forms of in-stent re stenosis occur, they tend to present earlier and with more symptoms includi ng myocardial infarction. More careful consideration of the type of in-sten t restenosis may aid in identifying when alternative strategies may be usef ul. (J Am Coll Cardiol 2001;37:1019-25) (C) 2001 by the American College of Cardiology.