Mechanism and prediction of restenosis after drug-eluting stent implantation in patients with hemodialysis

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We examined 423 consecutive patients to treat with drug-eluting stents (DES) with intravascular ultrasound (IVUS) guidance. Serial IVUS analysis was performed after stenting and at 8 months follow-up in hemodialysis patients (N=15, 1st Generation DES, D1=7, 2nd Generation DES, D2=8). Tissue characterization of neointima and plaque outside stent struts were performed using integrated backscatter IVUS. Instent restenosis occurred in each 1 patient. Neointima was mainly composed of fibrous tissue in each group (D1: 54%, D2:55%). Plaque outside stent struts increased in D1 (9%, mainly lipidic tissue), decreased in D2 (2%) at follow-up. Inflammation markers (CRP and PTX-3) were high at baseline, but did not associate with instent restenosis in both groups.In conclusion, both DES showed similar outcome in restenosis. However, D2 showed favorable effects on plaque outside stent struts without positive vessel remodeling.