Incidence, risk factors, and clinical sequelae of angiographic peri-stent contrast staining after sirolimus-eluting stent implantation.

Abstract

BACKGROUND:

We have noted abnormal angiographic findings--at the sites of drug-eluting stent implantation, suggesting contrast staining outside the stent struts--that do not fulfill the classic definition of coronary artery aneurysm. We propose a new term, peri-stent contrast staining (PSS), for these abnormal angiographic findings and assess their incidence, risk factors, and clinical sequelae.

METHODS AND RESULTS:

Peri-stent contrast staining was defined as contrast staining outside the stent contour extending to ≥20% of the stent diameter. The study population consisted of 3081 lesions (1998 patients) that were treated exclusively with sirolimus-eluting stents and were evaluated by follow-up angiography within 12 months after sirolimus-eluting stent implantation in a single center. Late acquired PSS was observed in 58 lesions (1.9%) in 49 patients (2.5%). Independent risk factors of PSS included chronic total occlusion, whereas negative risk factors for PSS were left circumflex coronary artery lesion and in-stent restenosis lesion. Stent fracture was more frequently observed in lesions with PSS than in lesions without PSS (43.1% versus 5.4%, P<0.0001). Excluding 269 lesions with target-lesion revascularization within 12 months, the study population for long-term follow-up consisted of 51 lesions (42 patients) with PSS and 2761 lesions (1751 patients) without PSS. Cumulative incidence of target-lesion revascularization and definite very late stent thrombosis at 3 years in the PSS group was higher than that in the non-PSS group (15.0% versus 6.5%, and 8.2% versus 0.2%, respectively).

CONCLUSIONS:

Peri-stent contrast staining found within 12 months after sirolimus-eluting stent implantation appeared to be associated with subsequent target-lesion revascularization and very late stent thrombosis.

• Authors: Masao Imai, Kazushige Kadota, Tsuyoshi Goto, Satoki Fujii, Hiroyuki Yamamoto, Yasushi Fuku, Shingo Hosogi, Akitoshi Hirono, Hiroyuki Tanaka, Takeshi Tada, Takeshi Morimoto, Hiroki Shiomi, Ken Kozuma, Katsumi Inoue, Nobuaki Suzuki, Takeshi Kimura, Kazuaki Mitsudo
• Journal: Circulation (Circulation) Vol. 123 Issue 21 Pg. 2382-91 (May 31 2011) ISSN: 1524-4539 [Electronic] United States
• PMID: 21576652 (Publication Type: Comparative Study, Journal Article)

Chemical References

• Contrast Media
• Sirolimus

Topics

• Aged
• Aged, 80 and over
• Angioplasty (adverse effects)
• Contrast Media (adverse effects)
• Coronary Angiography (adverse effects, methods)
• Coronary Artery Disease (chemically induced, diagnostic imaging, epidemiology)
• Drug-Eluting Stents (adverse effects)
• Female
• Follow-Up Studies
• Humans
• Incidence
• Male
• Middle Aged
• Retrospective Studies
• Risk Factors
• Sirolimus (administration & dosage, adverse effects)