Intra vascular ultrasound findings in drug eluting stent restenosis following emergent PCI for acute coronary syndrome – Gender based analysis

Optimal stent deployment attaining larger lumen area with image guidance (IVUS/OCT) may reduce the risk of re-stenosis. However imaging based optimization is often not performed in emergency procedures. We planned to prospectively evaluate intra vascular ultrasound (IVUS) findings in patients with in stent restenosis (ISR) who underwent emergency PCI for ACS. To find out the intra vascular ultrasound findings in drug eluting stent restenosis (DES-ISR). We enrolled consecutive patients with DES-ISR who had index PCI for ACS (NSTEMI/STEMI). IVUS analysis of individual lesions was performed for sub optimal stent deployment. Of the 1823 patients who had ACS PCI during the 5-year period, 172 patients {74 (9.4%) females and 88 males (8.4%)} had ISR. Eighty-two lesions in women were compared with 84 ISR lesions men. Baseline characteristics were similar except for presence of diabetes mellitus and multivessel disease. Females had more focal ISR (48 focal, 34 diffuse) compared to males (23 focal, 61 diffuse) (P < 0.001). The prevalence {38(46%) females and 33(39%)} and IVUS pattern of different mechanical factors (MF) with suboptimal stent deployment was not different between both sexes (P = 0.2). The occurrence of ISR was higher in women. Women had higher TLR and lower mean vessel size. In 46% of women and 39% men, a mechanical factor with sub optimal stent deployment was found. Longer stented length, diffuse disease, calcification and Type B/C lesion type were associated with under expanded and undersized stents.