Clinical research

DOI: 10.4244/EIJ-D-23-00107

Mechanisms and treatment outcomes of ostial right coronary artery in-stent restenosis

Kei Yamamoto1,2, MD; Takao Sato1,2, MD; Hanan Salem1,2,3, MD; Mitsuaki Matsumura2, BS; Khady N. Fall1, MD, MPH; Megha Prasad1, MD, MS; Vivian G. Ng1, MD; Sanjum S. Sethi1, MD; Tamim M. Nazif1,2, MD; Sahil A. Parikh1,2, MD; Torsten P. Vahl1,2, MD; Ziad A. Ali2,4, MD, DPhil; Dimitri Karmpaliotis2,5, MD, PhD; LeRoy E. Rabbani1,2, MD; Michael B. Collins1, MD; Martin B. Leon1,2, MD; Margaret B. McEntegart1,2, MD, PhD; Jeffery W. Moses1,2, MD; Ajay J. Kirtane1,2, MD, SM; Gary S. Mintz2, MD; Akiko Maehara1,2, MD

Abstract

Background: Despite a high rate of in-stent restenosis (ISR) after stenting the right coronary artery (RCA) ostium, the mechanism of ostial RCA ISR is not well understood.

Aims: We aimed to clarify the cause of ostial RCA ISR using intravascular ultrasound (IVUS).

Methods: Overall, 139 ostial RCA ISR lesions were identified with IVUS, pre-revascularisation. Primary ISR mechanisms were classified as follows: 1) neointimal hyperplasia (NIH); 2) neoatherosclerosis; 3) ostium not covered by the stent; 4) stent fracture or deformation; 5) stent underexpansion (old minimum stent area <4.0 mm2 or stent expansion <50%); or 6) a protruding calcified nodule.

Results: The median duration from prior stenting was 1.2 (first quartile 0.6, third quartile 3.1) years. The primary mechanisms of ISR were NIH in 25% (n=35) of lesions, neoatherosclerosis in 22% (n=30), uncovered ostium in 6% (n=9) (biological cause 53%, n=74), stent fracture or deformation in 25% (n=35), underexpansion in 11% (n=15), and protruding calcified nodules in 11% (n=15) (mechanical cause 47%, n=65). Including secondary mechanisms, 51% (n=71) of ostial RCA ISRs had stent fractures that were associated with greater...

Sign in to read
the full article

Forgot your password?
No account yet?
Sign up for free!

Create my pcr account

Join us for free and access thousands of articles from EuroIntervention, as well as presentations, videos, cases from PCRonline.com

Volume 19 Number 5
Aug 7, 2023
Volume 19 Number 5
View full issue


Key metrics

On the same subject

Original Research

10.4244/EIJ-D-23-00406 Feb 5, 2024
Ostial right coronary artery lesion morphology and outcomes after treatment with drug-eluting stents
Yamamoto K et al

State-of-the-Art Review

10.4244/EIJ-D-21-01034 Jun 3, 2022
Management of in-stent restenosis
Alfonso F et al
free

Clinical Research

10.4244/EIJ-D-21-00504 Mar 18, 2022
Prevalence, predictors, and outcomes of in-stent restenosis with calcified nodules
Tada T et al
free

Clinical research

10.4244/EIJ-D-20-00539 Aug 27, 2021
Predictors and outcomes of neoatherosclerosis in patients with in-stent restenosis
Nakamura D et al
free

Image – Interventional flashlight

10.4244/EIJ-D-20-00507 Aug 6, 2021
Optical coherence tomography and tailored treatment of in-stent restenosis
Jia H et al
free

CLINICAL RESEARCH

10.4244/EIJ-D-16-00679 Apr 7, 2017
Clinical, angiographic, IVUS, and OCT predictors for irregular protrusion after coronary stenting
Bryniarski K et al
free
Trending articles
281.53

State-of-the-Art Review

10.4244/EIJ-D-21-00695 Nov 19, 2021
Transcatheter treatment for tricuspid valve disease
Praz F et al
free
243.2

State of the art

10.4244/EIJ-D-21-01117 Sep 20, 2022
Recanalisation of coronary chronic total occlusions
Di Mario C et al
free
208.35

State-of-the-Art Review

10.4244/EIJ-D-21-01034 Jun 3, 2022
Management of in-stent restenosis
Alfonso F et al
free
168.7

Translational research

10.4244/EIJ-D-21-00824 May 15, 2022
Bench test and in vivo evaluation of longitudinal stent deformation during proximal optimisation
Toth GG et al
free
167.05

Expert review

10.4244/EIJ-D-21-00690 May 15, 2022
Crush techniques for percutaneous coronary intervention of bifurcation lesions
Moroni F et al
free
151.03

State-of-the-Art

10.4244/EIJ-D-22-00776 Apr 3, 2023
Computed tomographic angiography in coronary artery disease
Serruys PW et al
free
118

Translational research

10.4244/EIJ-D-22-00718 Jun 5, 2023
Preclinical evaluation of the degradation kinetics of third-generation resorbable magnesium scaffolds
Seguchi M et al
110.35

Viewpoint

10.4244/EIJ-E-22-00007 May 15, 2022
TAVI at 20: how a crazy idea led to a clinical revolution
Eltchaninoff H et al
free
X

The Official Journal of EuroPCR and the European Association of Percutaneous Cardiovascular Interventions (EAPCI)

EuroPCR EAPCI
PCR ESC
Impact factor: 6.2
2022 Journal Citation Reports®
Science Edition (Clarivate Analytics, 2023)
Online ISSN 1969-6213 - Print ISSN 1774-024X
© 2005-2024 Europa Group - All rights reserved