Contribution of Stent Underexpansion to Recurrence After Sirolimus-Eluting Stent Implantation for In-Stent Restenosis

Background— We used intravascular ultrasound (IVUS) to evaluate recurrence after sirolimus-eluting stent (SES) implantation treatment of in-stent restenosis (ISR). Methods and Results— Forty-eight ISR lesions (41 patients with objective evidence of ischemia) were treated with SES. Recurrent ISR was identified in 11 lesions (all focal); repeat revascularization was performed in 10. These were compared with 16 patients (19 lesions) without recurrence as documented by angiography. Nine of 11 recurrent lesions had a minimum stent area (MSA) <5.0 mm 2 versus 5 of 19 nonrecurrent lesions ( P =0.003); 7 of 11 recurrent lesions had an MSA <4.0 mm 2 versus 4 of 19 nonrecurrent lesions ( P =0.02); and 4 of 11 recurrent lesions had an MSA <3.0 mm 2 versus 1 of 19 nonrecurrent lesions ( P =0.03). A gap between SESs was identified in 3 of 11 recurrences versus 1 of 19 nonrecurrent lesions. Conclusions— Stent underexpansion is a significant cause of failure after SES implantation treatment of ISR.