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. 2022 Mar 18;17(16):1352-1361.
doi: 10.4244/EIJ-D-21-00504.

Prevalence, predictors, and outcomes of in-stent restenosis with calcified nodules

Takeshi Tada  1 , Katsuya Miura  1 , Akihiro Ikuta  1 , Masanobu Ohya  1 , Takenobu Shimada  1 , Kohei Osakada  1 , Makoto Takamatsu  1 , Yuya Taguchi  1 , Shunsuke Kubo  1 , Hiroyuki Tanaka  1 , Yasushi Fuku  1 , Kazushige Kadota  1
Affiliations

Prevalence, predictors, and outcomes of in-stent restenosis with calcified nodules

Takeshi Tada et al. EuroIntervention. .

Abstract

Background: Calcified nodules (CN) have been reported as being associated with stent failure including in-stent restenosis (ISR). However, there is no systematic study of this condition.

Aims: We aimed to clarify the prevalence, predictors, and midterm results of ISR lesions with CN.

Methods: We examined the clinical characteristics of 651 ISR lesions in patients who underwent percutaneous coronary intervention (PCI) with optical coherence tomography (OCT) between October 2008 and July 2016, and their 6- to 8-month follow-up angiography results. CN was defined as a high backscattering mass with small nodular calcium depositions which protruded into the vessel lumen.

Results: Thirty-two ISR lesions (4.9%) had CN. Multivariable analysis showed that calcified lesion (odds ratio [OR] 12.441, p<0.001), incomplete stent apposition (OR 3.228, p=0.005), haemodialysis (OR 3.633, p=0.024), and female gender (OR 3.212, p=0.036) were independently associated with ISR lesions with CN. Midterm follow-up was performed on 612 ISR lesions. Both ISR and target lesion revascularisation (TLR) rates were significantly higher in lesions with CN compared with those without CN (43.8% vs 25.0%, p=0.023; 37.5% vs 18.8%, p=0.020, respectively). However, multivariate analysis did not show the presence of CN as an independent predictor of re-TLR (OR 1.690, p=0.286).

Conclusions: The prevalence of ISR lesions with CN was 4.9%. Calcified lesions, incomplete stent apposition, haemodialysis, and female gender are probably associated with CN formation. ISR lesions with CN may have poor midterm outcomes compared with ISR lesions without CN.

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Conflict of interest statement

T. Tada has received lecture fees from Terumo Corporation and Abbott Vascular. K. Kadota has received lecture fees from Terumo Corporation and Abbott Vascular. S. Kubo has received lecture fees from Abbott Vascular. The other authors have no conflicts of interest to declare.

Figures

Figure 1
Figure 1. Study flow diagram.
CAG: coronary angiography; CN: calcified nodule; ISR: in-stent restenosis; OCT: optical coherence tomography; OFDI: optical frequency domain imaging; PCI: percutaneous coronary intervention
Central illustration
Central illustration. Two representative cases of ISR lesions with calcified nodules.
Case 1: A) An ISR lesion was observed in the mid portion of the right coronary artery three years after paclitaxel-eluting stent implantation in a 55-year-old HD patient (white arrows). B) Magnified view of the lesion. C) & D) OCT images showed a protruding irregular mass with the deposition of small nodular calcification (asterisks). Case 2: E) An ISR lesion was observed in the mid portion of the right coronary artery one year after platinum-chromium everolimus-eluting stent implantation in an 81-year-old HD patient (white arrows). F) Magnified view of the lesion. G) & H) OCT images showed a protruding irregular mass with the deposition of small nodular calcification (asterisks).
Figure 2
Figure 2. Midterm (6 to 8 months) results after PCI for ISR lesions with and without CN.
The ISR and TLR rates in lesions with CN were significantly higher than those in lesions without CN. CN: calcified nodule; ISR: in-stent restenosis; PCI: percutaneous coronary intervention; TLR: target lesion revascularisation
Figure 3
Figure 3. The association between midterm results and PCI devices in lesions with and without CN.
In lesions treated with both PCB and DES, both ISR (panel A) and TLR (panel B) rates were significantly higher in lesions with CN than in those without CN. CN: calcified nodule; DES: drug-eluting stent; ISR: in-stent restenosis; PCI: percutaneous coronary intervention; PCB: paclitaxel-coated balloon; POBA: plain old balloon angioplasty; TLR: target lesion revascularisation
See this image and copyright information in PMC

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