Mechanisms and treatment outcomes of ostial right coronary artery in-stent restenosis
Authors' conclusion
Half of the ostial RCA ISRs were due to mechanical causes. Subsequent event rates were high, especially in mechanically caused ISRs treated without the implantation of a new stent.
Study context
- Population
- Ostial right coronary artery in-stent restenosis lesions assessed by intravascular ultrasound before revascularisation
- Participants
- 139 in-stent restenosis (ISR) lesions
- Outcome
- Primary mechanism of ISR (NIH, neoatherosclerosis, uncovered ostium, stent fracture or deformation, underexpansion, protruding calcified nodule)
Main finding
As reported in the abstract
Primary ISR mechanism
- Neointimal hyperplasia (NIH)
- 25% (n=35)
- Neoatherosclerosis
- 22% (n=30)
- Uncovered ostium
- 6% (n=9)
- Biological cause
- 53%, n=74
- Stent fracture or deformation
- 25% (n=35)
- Underexpansion
- 11% (n=15)
- Protruding calcified nodules
- 11% (n=15)
- Mechanical cause
- 47%, n=65
Observational data: associations, not effects.
Further findings
| Outcome | Mechanical ISR treated without new stents | Non-mechanical causes or mechanical causes treated without restenting | HR (95% CI) | P value | |
|---|---|---|---|---|---|
| Subsequent event rate, mechanically caused ISR treated without new stentsvs othersUnadjusted | 41.4% | 7.8% | 6.44 (2.33–17.78) | P < 0.0001 | |
| 0.050.21520Hazard ratio (log scale) |
Duration from prior stenting
- Median duration from prior stenting (first quartile 0.6, third quartile 3.1 years)
- 1.2 years
Stent fracture including secondary mechanisms
- Stent fractures, associated with greater hinge motion of ostial-aorta angle during cardiac cycle
- 51% (n=71)
Target lesion failure (Kaplan-Meier) · 1 year
- Kaplan-Meier rate of target lesion failure
- 11.5%
Original publication
Mechanisms and treatment outcomes of ostial right coronary artery in-stent restenosis. EuroIntervention. Published 7 August 2023. doi:10.
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