in-stent restenosis – ABC CARDIOL

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Impact of Neointimal Calcifications on Acute Stent Performance during the Treatment of In-Stent Restenosis

Emile Mehanna et al. Guilherme Ferragut Attizzani Daisuke Nakamura Setsu Nishino … Anas Fares Reem Aoun Marco Aurelio Costa Hiram Grando Bezerra

Abstract

Optical coherence tomography (OCT) has become the invasive imaging modality of choice for coronary stent assessment due to its unmatched spatial resolution. Neointimal calcification (NC) is a rare finding, observed in 5-10% of in-stent restenosis (ISR) neointima. The impact of NC on percutaneous coronary intervention of ISR is unknown. We therefore present the outcome of six unique cases of ISR and NC in which OCT was used to evaluate the impact of NC on the quality of stent-in-stent deployment for the treatment of ISR. This series demonstrates for the first time the impact of NC on stent expansion, a finding which might help guiding percutaneous coronary intervention for ISR with NC.

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Artigo Original

Clinical outcome of renal transplant patients after coronary stenting

Fábio Monteiro Mota et al. Juliana Araújo José Airton Arruda Hélio T. S. Júnior … José O. M. Pestana José Marconi A. de Sousa Valter C. Lima

OBJECTIVE: To assess the clinical outcome of renal transplant patients who developed coronary artery disease and were treated with coronary stenting (TCA-ST). METHODS: A total of 3,334 renal transplants were performed in our service – Hospital do Rim e Hipertensão – HRH (Kidney and Hypertension Hospital) from July, 1998 to November, 2004. During this period, 33 of the renal transplant patients underwent TCA-ST to treat 62 severe stenoses in 54 coronary arteries. A retrospective analysis was performed with renal transplant patients undergoing TCA-ST at HRH. The clinical events were registered using medical charts, medical visits and phone calls. RESULTS: During the 30-month clinical follow-up after TCA-ST, 67% of the patients remained asymptomatic, 18% presented stable angina, 6% presented acute coronary syndrome without ST-segment elevation (ACSWSTE), and 3% presented acute coronary syndrome with ST-segment elevation (ACSSTE). No strokes, CHF or cardiac deaths were observed. Three non-cardiac deaths occurred. A restenosis rate of 9% was observed, which is comparable to those found in studies on drug-eluting stents. CONCLUSION: In conclusion, renal transplant patients who developed CAD and were treated with coronary stenting had a low rate of in-stent restenosis, probably related to the immunosuppressive regimen given to prevent kidney rejection.

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Intracoronary brachytherapy. Treatment of in-stent restenosis with the Beta-Cath system: initial experience in Latin America

Juan Simon Muñoz et al. Fausto Feres Alexandre C. Abizaid Luiz A. Mattos … Rodolfo Staico Marinella Centemero Luiz F. Tanajura Ibraim Pinto Amanda G.M.R. Sousa J. Eduardo Sousa

OBJECTIVE: To assess the safety and efficacy of intracoronary brachytherapy using the Beta-Cath systemTM for preventing recurrence of in-stent restenosis (ISR), by analyzing clinical, angiographic, and intracoronary ultrasound (ICUS) results. METHODS: This study assessed 30 patients with ISR in native coronary arteries who underwent balloon catheter angioplasty followed by intracoronary beta radiation with the Beta-Cath systemTM (90Sr/Y). RESULTS: The study comprised complex, extensive (18.66±4.15 mm) restenotic lesions, 77% of which were of the diffuse-proliferative type. Brachytherapy was successful in 100% of the cases. The mean radiation dose used was 20.7±2.3 Gy, released for a mean period of 3.8±2.1 minutes. On late follow-up, the in-stent minimum luminal diameter (MLD) slightly decreased (from 1.98±0.30 mm to 1.84±0.39 mm at 6 months; P=0.13), with a late loss of 0.14±0.18 mm. The intrasegmentary MLD was significantly smaller than the in-stent diameter (1.55±0.40 mm vs 1.84±0.39 mm; P=0.008), and was associated with a more significant late loss (0.40±0.29 mm vs 0.14±0.18 mm; P=0.0001). On ICUS, a mild increase of 6.8±14.3 mm³ in the neointimal tissue was observed at 6 months (P=0.19), and the percentage of volumetric obstruction increased by 4.7±7.5%. Binary restenosis and revascularization of the target vessel recurred in 17% of the cases; late occlusion associated with myocardial infarction occurred in 1 case (3%). Event-free survival was 80%. CONCLUSION: The management of in-stent restenosis with intracoronary beta radiation proved to be a safe and effective procedure, with a high rate of immediate success, representing a therapeutic option for inhibiting neointimal hyperplasia.

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Impact of Neointimal Calcifications on Acute Stent Performance during the Treatment of In-Stent Restenosis

Abstract

Clinical outcome of renal transplant patients after coronary stenting

Intracoronary brachytherapy. Treatment of in-stent restenosis with the Beta-Cath system: initial experience in Latin America

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