Sirolimus-Eluting Stents Inhibit New and Recurrent Lesions

Sirolimus eluting stents prevent neointimal proliferation in de novo and in in-stent restenosis lesions without inducing positive vascular remodeling, according to a report in the January issue of the European Heart Journal.

Previous studies have documented the reduction of late luminal renarrowing after coronary intervention associated with the use of sirolimus eluting stents (SES), the authors explain, but the influence of SES on vascular remodeling and edge restenosis has not been evaluated in patients with in-stent restenosis.

Dr. Patrick W. Serruys from Erasmus Medical Center, Rotterdam, the Netherlands and colleagues used serial volumetric intravascular ultrasound to compare the vessel responses of de novo (n=45) and in-stent restenosis (n=41) lesions treated with SES implantation.

At follow-up, the patients with de novo and in-stent restenosis did not differ with respect to changes in the mean external elastic membrane area, plaque behind the stent or lumen areas, the authors report.

Moreover, there was no significant positive remodeling or edge effect (restenosis at the stent margins), the report indicates.

Post-procedure lumen area was the only independent predictor of mean lumen area at follow-up, the researchers note. However, there were no reliable predictors of neointimal area and mean percent area obstruction at follow-up.

“These findings suggest that the therapeutic effect of SES is solely due to inhibition of neointimal hyperplasia without inducing positive vascular remodeling in either de novo or in-stent restenosis lesions,” the investigators conclude.

“SES implantation appears to be highly successful in the short-term follow-up,” Dr. Serruys told Reuters Health. “However, late subacute thrombosis must be prevented with long-term Plavix and very late outcome (> 3 years) is largely unknown.”

“From other studies it would appear that SES could be used for short lesions in large vessels (> 3.0 mm in diameter),” Dr. Serruys added. “Preliminary results also indicate that SES may be useful in smaller vessels, longer lesions, and in diabetics.”

Eur Heart J 2004;25:32-38.