An integrated TAXUS IV, V, and VI intravascular ultrasound analysis of the predictors of edge restenosis after bare metal or paclitaxel-eluting stents

Abstract

We used intravascular ultrasound data after stent implantation from the TAXUS IV, V, and VI trials to determine predictors of angiographic stent edge restenosis. In the combined TAXUS IV, V, and VI trials, intravascular ultrasound was performed at implantation in 255 patients with bare metals stents (BMSs) and 276 patients with paclitaxel-eluting stents who underwent quantitative coronary angiography at 9 months. At follow-up, 6 BMSs (2.5%) had proximal edge and 6 BMSs (2.4%) had distal edge angiographic restenosis; 14 TAXUS stents (5.2%) had proximal edge and 1 TAXUS stent (0.4%) had distal edge angiographic restenosis. Although univariate analysis identified external elastic membrane, lumen areas, and plaque burden (external elastic membrane minus lumen/ external elastic membrane) as predictors of 9-month angiographic edge restenosis in the overall cohort and in BMS- and TAXUS-treated patients separately, only edge plaque burden was an independent predictor of 9-month angiographic edge restenosis. Receiver operator characteristic analysis showed that residual plaque burden, but not edge lumen area, was predictive of 9-month angiographic edge restenosis in BMS-treated patients (cutoff 47.7%, c = 0.70, p = 0.0244) and in TAXUS-treated patients (cutoff 47.1%, c = 0.69, p = 0.0137). In conclusion, residual edge plaque burden predicts stent edge restenosis after BMS or TAXUS stent implantation and the optimal plaque burden for stent edge landing zones are the same for BMSs and TAXUS stents, independent of vessel size and edge lumen dimensions.