A novel quantitative method for evaluating diffuse in-stent narrowing at follow-up angiography
Yasuhiro Ishii MD
Department of Radiology, Leiden University Medical Center, Leiden, The Netherlands
Heart Core B.V., Leiden, The Netherlands
Department of Cardiology, Leiden University Medical Center, Leiden, The Netherlands
Search for more papers by this authorAnton W.M. van Weert PhD
Heart Core B.V., Leiden, The Netherlands
Search for more papers by this authorPranobe V. Oemrawsingh MD
Department of Cardiology, Leiden University Medical Center, Leiden, The Netherlands
Department of Radiology, Leiden University Medical Center, Leiden, The Netherlands
Search for more papers by this authorCorresponding Author
Johan H.C. Reiber PhD
Department of Radiology, Leiden University Medical Center, Leiden, The Netherlands
Heart Core B.V., Leiden, The Netherlands
Department of Cardiology, Leiden University Medical Center, Leiden, The Netherlands
In accordance with the policy of the Journal, the designated author discloses a financial or other interest in the subject discussed in this article.
Department of Radiology, C2-S, Leiden University Medical Center, Albinusdreef 2, P.O. Box 9600, 2300 RC Leiden, The NetherlandsSearch for more papers by this authorYasuhiro Ishii MD
Department of Radiology, Leiden University Medical Center, Leiden, The Netherlands
Heart Core B.V., Leiden, The Netherlands
Department of Cardiology, Leiden University Medical Center, Leiden, The Netherlands
Search for more papers by this authorAnton W.M. van Weert PhD
Heart Core B.V., Leiden, The Netherlands
Search for more papers by this authorPranobe V. Oemrawsingh MD
Department of Cardiology, Leiden University Medical Center, Leiden, The Netherlands
Department of Radiology, Leiden University Medical Center, Leiden, The Netherlands
Search for more papers by this authorCorresponding Author
Johan H.C. Reiber PhD
Department of Radiology, Leiden University Medical Center, Leiden, The Netherlands
Heart Core B.V., Leiden, The Netherlands
Department of Cardiology, Leiden University Medical Center, Leiden, The Netherlands
In accordance with the policy of the Journal, the designated author discloses a financial or other interest in the subject discussed in this article.
Department of Radiology, C2-S, Leiden University Medical Center, Albinusdreef 2, P.O. Box 9600, 2300 RC Leiden, The NetherlandsSearch for more papers by this authorAbstract
A new quantitative parameter, diffuse index (DI), was proposed to evaluate objectively whether in-stent restenosis is diffuse or focal in nature. A total of 343 patients (346 lesions) with Wiktor-GX, AVE MS-II, or JOMED stents were evaluated at follow-up angiography. According to the QCA-CMS definition, lesion length is derived from the 100% reference diameter function (RDF). By moving the RDF downward, the lesion length, LL(x), at each percentage x of the RDF can be calculated. We have defined the DI by the ratio of this calculated length LL(x) and the total stent length, SL, in other words, DI = [LL(x)/SL]. The percentage plaque area (% PA) was calculated by dividing the plaque area by the sum of the plaque area and luminal area within the stent. An excellent correlation was found between the DI at 88% RDF and the % PA in all three stents (r > 0.88). The individual correlation curves were nearly identical, independent of the type of stent. Furthermore, based on the overall data, the combination of a DI > 0.8 and % PA > 30% correlated with a high incidence of subsequent major adverse cardiac events (13/25 = 52%). From these data, it can be concluded that the diffuse index is a new objective quantitative parameter to describe whether in-stent restenosis is of focal or diffuse nature. Cathet Cardiovasc Intervent 2001;54:309–317. © 2001 Wiley-Liss, Inc.
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