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Right coronary artery (RCA) ostial lesions are reported to be a risk factor of restenosis in patients undergoing drug-eluting stent (DES) implantation. We aimed to clarify the relationship between intravascular ultrasound (IVUS) findings in right coronary artery (RCA) ostial lesions and restenosis occurring within 1 year after second-generation DES implantation.
The study sample comprised 140 patients (140 lesions) undergoing IVUS-guided 3.5-mm second-generation DES implantation in de novo RCA ostial lesions and follow-up angiography within 1 year after the procedure. The presence or absence of calcification, minimum lumen area, and external elastic membrane (EEM) area within 10 mm from the ostium before the procedure and the stent area after the procedure were assessed. A stent to vessel ratio (SVR) was defined as a ratio of the ostial stent area to the EEM area. IVUS findings were compared between patients with and without restenosis (restenosis and nonrestenosis groups).
Restenosis occurred in 13.6% (19/140 lesions). Between the restenosis and nonrestenosis groups, no significant differences existed in the minimum lumen area (3.8±1.4 mm2 vs. 4.5±2.5 mm2, p=0.22) and the EEM area (20.0±5.5 mm2 vs. 20.7±6.1 mm2, p=0.61), but the calcification rate was significantly higher in the restenosis group (52.6% vs. 24.8%, p=0.01), and the postprocedural stent area and SVR were significantly smaller in the restenosis group (11.7±3.0 mm2 vs. 14.2±3.7 mm2, p=0.01 and 0.60±0.15 vs. 0.71±0.18, p=0.22, respectively). The cut-off value of SVR to predict restenosis was 0.70 (area under the curve: 0.70), and the relationship between calcification, SVR, and restenosis is shown in the table.
|Stent to vessel ratio||p value|
|Calcification||(+)||29.2% (7/24)||18.8% (3/16)||0.46|
|(-)||14.3% (8/56)||2.3% (1/44)||0.04|
Calcification in RCA ostial lesions was related to restenosis after second-generation DES implantation. Even with a SVR ≥0.7, calcified RCA ostial lesions require careful follow-up.
IMAGING: Imaging: Intravascular