Document Detail

Re-examining minimal luminal diameter relocation and quantitative coronary angiography--intravascular ultrasound correlations in stented saphenous vein grafts: methodological insights from the randomised RRISC trial.
MedLine Citation:
PMID:  19378685     Owner:  NLM     Status:  MEDLINE    
AIMS: Angiographic parameters (such as late luminal loss) are common endpoints in drug-eluting stent trials, but their correlation with the neointimal process and their reliability in predicting restenosis are debated. METHODS AND RESULTS: Using quantitative coronary angiography (QCA) data (49 bare metal stent and 44 sirolimus-eluting stent lesions) and intravascular ultrasound (IVUS) data (39 bare metal stent and 34 sirolimus-eluting stent lesions) from the randomised Reduction of Restenosis In Saphenous vein grafts with Cypher stent (RRISC) trial, we analysed the "relocation phenomenon" of QCA-based in-stent minimal luminal diameter (MLD) between post-procedure and follow-up and we correlated QCA-based and IVUS-based restenotic parameters in stented saphenous vein grafts. We expected the presence of MLD relocation for low late loss values, as MLD can "migrate" along the stent if minimal re-narrowing occurs, while we anticipated follow-up MLD to be located close to post-procedural MLD position for higher late loss. QCA-based MLD relocation occurred frequently: the site of MLD shifted from post-procedure to follow-up an "absolute" distance of 5.8 mm [2.5-10.2] and a "relative" value of 29% [10-46]. MLD relocation failed to correlate with in-stent late loss (rho = 0.14 for "absolute" MLD relocation [p = 0.17], and rho=0.03 for "relative" relocation [p = 0.811). Follow-up QCA-based and IVUS-based MLD values well correlated in the overall population (rho = 0.76, p < 0.001), but QCA underestimated MLD on average 0.55 +/- 0.49 mm, and this was mainly evident for lower MLD values. Conversely, the location of QCA-based MLD failed to correlate with the location of IVUS-based MLD (rho = 0.01 for "absolute" values--in mm [p = 0.911, rho = 0.19 for "relative" values--in % [p = 0.111). Overall, the ability of late loss to "predict" IVUS parameters of restenosis (maximum neointimal hyperplasia diameter, neointimal hyperplasia index and maximum neointimal hyperplasia area) was moderate (rho between 0.46 and 0.54 for the 3 IVUS parameters). CONCLUSIONS: These findings suggest the need for a critical re-evaluation of angiographic parameters (such as late loss) as endpoints for drug-eluting stent trials and the use of more precise techniques to describe accurately and properly the restenotic process.
Oscar Semeraro; Pierfrancesco Agostoni; Stefan Verheye; Glenn Van Langenhove; Paul Van den Heuvel; Carl Convens; Frank Van den Branden; Nico Bruining; Paul Vermeersch;
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Publication Detail:
Type:  Comparative Study; Journal Article; Randomized Controlled Trial    
Journal Detail:
Title:  EuroIntervention : journal of EuroPCR in collaboration with the Working Group on Interventional Cardiology of the European Society of Cardiology     Volume:  4     ISSN:  1774-024X     ISO Abbreviation:  -     Publication Date:  2009 Mar 
Date Detail:
Created Date:  2009-04-21     Completed Date:  2009-05-14     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  101251040     Medline TA:  EuroIntervention     Country:  France    
Other Details:
Languages:  eng     Pagination:  633-40     Citation Subset:  IM    
Antwerp Cardiovascular Institute Middelheim, Ziekenhuis Netwerk Antwerpen, Antwerp, Belgium.
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MeSH Terms
Angioplasty, Transluminal, Percutaneous Coronary / instrumentation*
Cardiovascular Agents / administration & dosage
Coronary Angiography*
Coronary Artery Bypass / adverse effects*
Coronary Restenosis / etiology,  pathology,  therapy*
Double-Blind Method
Drug-Eluting Stents
Graft Occlusion, Vascular / etiology,  pathology,  therapy*
Predictive Value of Tests
Prosthesis Design
Reproducibility of Results
Saphenous Vein / pathology*,  radiography,  ultrasonography
Sirolimus / administration & dosage
Time Factors
Treatment Outcome
Ultrasonography, Interventional*
Vascular Patency*
Reg. No./Substance:
0/Cardiovascular Agents; 0/Metals; 53123-88-9/Sirolimus

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