Formation of Calcified Nodule as a Cause of Early In-Stent Restenosis in Patients Undergoing Dialysis

• Published in: Journal of the American Heart Association 2020-10, Vol.9 (19), p.e016595-e016595
• Main Authors: Nakamura, Norihito, Torii, Sho, Tsuchiya, Hiroko, Nakano, Akihiko, Oikawa, Yuji, Yajima, Junji, Nakamura, Shigeru, Nakano, Masataka, Masuda, Naoki, Ohta, Hiroshi, Yumoto, Kazuhiko, Natsumeda, Makoto, Ijichi, Takeshi, Ikari, Yuji, Nakazawa, Gaku
• Format: Article
• Language: English
• Subjects: Aged; Atherectomy, Coronary - methods; Atherectomy, Coronary - statistics & numerical data; calcified nodule; Calcinosis - diagnostic imaging; Calcinosis - pathology; Coronary Angiography - methods; Coronary Restenosis - etiology; Coronary Restenosis - pathology; Coronary Vessels - diagnostic imaging; Coronary Vessels - pathology; Coronary Vessels - surgery; dialysis; directional coronary atherectomy; Drug-Eluting Stents - adverse effects; Female; Humans; in‐stent restenosis; Male; Original Research; Outcome and Process Assessment, Health Care; Percutaneous Coronary Intervention - adverse effects; Percutaneous Coronary Intervention - instrumentation; Percutaneous Coronary Intervention - methods; Registries; Renal Dialysis - adverse effects; Renal Dialysis - statistics & numerical data; Risk Assessment; Risk Factors; Severity of Illness Index
• ISSN: 2047-9980; 2047-9980
• DOI: 10.1161/JAHA.120.016595

Background Dialysis is an independent risk factor for in-stent restenosis (ISR) after stent implantation in coronary arteries. However, the characteristics of ISR in patients undergoing dialysis remain unclear, as there are no histological studies evaluating the causes of this condition. The aim of the present study was to investigate the causes of ISR between patients who are undergoing dialysis and those who are not by evaluating tissues obtained from ISR lesions using directional coronary atherectomy. Methods and Results A total of 29 ISR lesions from 29 patients included in a multicenter directional coronary atherectomy registry of 128 patients were selected for analysis and divided into a dialysis group (n=8) and a nondialysis group (n=21). Histopathological evaluation demonstrated that an in-stent calcified nodule was a major histological characteristic of ISR lesions in the dialysis group and the prevalence of an in-stent calcified nodule was significantly higher in the dialysis group compared with the nondialysis group (75% versus 5%, respectively;