Predictors of diffuse and aggressive intra-stent restenosis

OBJECTIVES This study was performed to investigate the causes of diffuse and aggressive intra-stent restenosis. BACKGROUND Although restenosis is usually considered to be a dichotomous variable, there is clinical relevance to the severity of restenosis. It is not known which variables are predictive of diffuse or aggressive intra-stent restenosis. METHODS A consecutive series of 456 coronary lesions with in-stent restenosis was evaluated for the type of restenosis using quantitative coronary angiography. Restenosis was defined as greater than or equal to 50% diameter stenosis at follow-up angiography, diffuse restenosis as a follow-up lesion length greater than or equal to 10 mm and aggressive restenosis as either ail increase in lesion length from the original lesion or a restenotic narrowing tighter than the original. Clinical, anatomic and procedural characteristics were evaluated fur lesions associated with these types of restenosis. RESULTS Diffuse restenosis was associated with a smaller reference artery diameter, longer lesion length, female gender, longer stent length and the use of soil stents. Aggressive restenosis was more common in women, with the use of Wallstents and with long stent tu lesion length ratios. Aggressive restenosis occurred earlier and was more closely associated with symptoms and myocardial inflictions than nonaggressive restenotic lesions. CONCLUSIONS Markers for diffuse restenosis were also important markers for the presence of any restenosis. A long stent to lesion length ratio is an important marker for aggressive restenosis. When severe forms of in-stent restenosis occur, they tend to present earlier and with more symptoms including myocardial infarction. More careful consideration of the type of in-stent restenosis may aid in identifying when alternative strategies may be useful. (J Am Coll Cardiol 2001;37:1019-25) (C) 2001 by the American College of Cardiology.