Post-Sirolimus-Eluting Stent Restenosis Treated With Repeat Percutaneous Intervention: Late Angiographic and Clinical Outcomes (original) (raw)
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Post–Sirolimus-Eluting Stent Restenosis Treated With Repeat Percutaneous Intervention
Circulation, 2004
Background— We evaluated the clinical and angiographic outcomes of patients presenting with restenosis after sirolimus-eluting stent (SES) implantation treated with repeated percutaneous intervention. Methods and Results— A total of 24 consecutive patients have undergone repeated percutaneous intervention to treat post-SES restenosis (27 lesions). The restenosis was located within the stent in 93% of lesions. From the 27 lesions, 1 (4%) was re-treated with a bare stent, 3 (11%) were treated with balloon dilatation, and the remaining 23 lesions (85%) were treated with repeated drug-eluting stent implantation (SES in 12 lesions [44%], paclitaxel-eluting stents in 11 lesions [41%]). The event-free survival rate was 70.8% after a median follow-up of 279 days from the post-SES treatment. The overall recurrent restenosis rate was 42.9%. The risk of recurrent restenosis was increased for patients with hypercholesterolemia, previous angioplasty, failed brachytherapy, post-SES restenosis nee...
The American Journal of Cardiology, 2006
This study compared the safety and efficacy of repeat percutaneous coronary intervention (PCI) using sirolimus-eluting stents (SESs) with conventional therapies for restenosis after drug-eluting stent placement. Fifty-five consecutive patients with 58 restenotic lesions (31 treated with SESs and 27 treated with paclitaxel-eluting stents) underwent PCI using SESs (33 lesions) or conventional therapies comprising cutting balloon angioplasty alone (11 lesions) or intracoronary brachytherapy (14 lesions). Baseline characteristics were similar for the 2 groups, except for greater edge involvement (75.8% vs 36.0%, p ؍ 0.002) and less stent expansion (0.74 ؎ 0.17 vs 0.95 ؎ 0.21, p ؍ 0.006) in the SES group than in the conventional group. The SES group achieved a greater postprocedural luminal gain than the conventional group (1.98 ؎ 0.50 vs 1.22 ؎ 0.48 mm, p <0.001). Follow-up angiography showed that late luminal loss (0.27 ؎ 0.56 vs 0.76 ؎ 0.84 mm, p ؍ 0.021) and recurrent angiographic restenosis rate (3.6% vs 35.0%, p ؍ 0.006) were lower in the SES group than in the conventional group. The repeated target lesion revascularization-free survival rates at 1 year were 96.7 ؎ 3.2% for the SES group and 91.7 ؎ 5.6% for the conventional group (p ؍ 0.399). In conclusion, use of SESs was associated with a lower recurrent restenosis rate compared with conventional therapies.
Journal of the Saudi Heart Association, 2017
The treatment of patients with repeated drug-eluting stent-in stent restenosis (DES-ISR) remains a challenge and a burdensome clinical problem. Over a 3-year period, 130 lesions in 123 patients who underwent target lesion revascularization (TLR) for DES restenosis were included in the study. They were classified into two main groups: the first group having first-time DES-ISR (n = 84), and the second group having rerestenosis of DES-treated DES-ISR (n = 39). Further classification according to the treatment strategy yielded four subgroups: balloon angioplasty (BA) in first-time DES-ISR (n = 66), re-DES in the same group (n = 22), BA in rerestenosis of DES-treated DES-ISR (n = 30), and re-DES in the same group (n = 10). Angiographic follow-up was planned at 1 year, and clinical follow-up for re-TLR up to 2 years later. The mean duration of clinical follow-up was 24.8 ± 9.7 months. The angiographic follow-up data were obtained for 108 patients (87.8%) at 1 year. Among patients treated ...
International Journal of Cardiology, 2011
This study compared the impact of pattern of sirolimus eluting stent restenosis (SES ISR) on the angiographic outcomes following conventional modalities of treatment. Methods: A total of 344 consecutive patients who underwent treatment for SES ISR were included in the study. Lesions were divided into focal b 10 mm, 156 (45.3%)); and non focal N 10 mm, 188 (54.7%). The endpoints analysed were angiographic restenosis and target lesion revascularisation. A total of 31%, 41%, and 23% patients were treated with cutting balloon angioplasty, balloon angioplasty, and repeat stenting. Results: Baseline characteristics were similar for two patterns, except for young age, more AMI and severe angina, more CTO lesions, long lesions, and more use of repeat stenting in non focal ISR group. Follow up angiography shows binary restenosis was significantly lower in the focal group (32.4% vs. 49.2; p = 0.012) and target lesion revascularisation were also lower with focal pattern ISR (30.6 vs. 42.9; p = 0.06). Restenosis rates are similar between balloon angioplasty and repeat stenting (28 vs. 23%) in focal ISR group, and repeat stenting showed better outcomes in the non focal group (60% vs. 36%). Conclusion: The recurrent ISR remains high with available treatments and the pattern of SES ISR predicted the outcomes, with lower restenosis rates with focal pattern of ISR.
Italian heart journal: official journal of the Italian Federation of Cardiology, 2005
Background: Sirolimus-eluting stents have already proved to be efficient in the prevention of restenosis in de novo lesions and have been already proposed as a potential treatment of in-stent restenosis. In the present study, we evaluated the effectiveness of sirolimus-eluting stent implantation in unselected patients with in-stent restenosis. Methods: Fifty consecutive patients (59 lesions) were treated with sirolimus-eluting stents for instent restenosis. The incidence of major adverse cardiovascular events and restenosis was evaluated at 1-year clinical and angiographic follow-up. Results: At baseline, 54% of the lesions were complex (46% proliferative and 8% total occlusions). Small vessel size (< or = 2.5 mm) was present in 30%, a long lesion (> 20 mm) in 25%, and diabetes in 42% of the patients. The angiographic follow-up was obtained in 47 patients (55 lesions). Restenosis was observed in 13% of the lesions. At the 1-year follow-up, the incidence of major adverse cardiovascular events was 16% (4% acute myocardial infarction, 12% target lesion revascularization). Conclusions: This study confirms the efficacy of sirolimus-eluting stents for the treatment of instent restenosis in an unselected population of consecutive patients at high risk of restenosis and with a broad range of morphological lesion patterns.
Circulation, 2005
Background-In-stent restenosis is notoriously difficult to treat by repeat catheter intervention because of its propensity for aggressive recurrent neointimal formation. This study sought to assess the effectiveness and safety of the sirolimus-eluting stent in the treatment of in-stent restenosis. Methods and Results-The study was designed as a prospective multicenter registry. We included 162 patients with in-stent restenosis of a native coronary artery who had a clinical indication for repeat intervention. Patients were scheduled for follow-up angiography at 6 months. The primary end point was in-lesion late loss. Follow-up angiography was performed in 155 patients. We obtained an in-lesion late loss of 0.08Ϯ0.49 mm and a binary restenosis rate of 9.7% (15/155), which prompted reintervention in 7.4% (12/162) at 9 months. The 9-month rate of death was 1.2% (2/162) and that of nonfatal myocardial infarction was 1.2% (2/162). Conclusions-Sirolimus-eluting stents were highly efficacious and safe in the treatment of in-stent restenosis. Our study provides rationale for the use of sirolimus-eluting stents in the treatment of in-stent restenosis.
Circulation, 2010
Background-Optimal treatment strategies for restenosis of sirolimus-eluting stents (SES) have not been adequately addressed yet. Methods and Results-During the 3-year follow-up of 12 824 patients enrolled in the j-Cypher registry, 1456 lesions in 1298 patients underwent target-lesion revascularization (TLR). Excluding 362 lesions undergoing TLR for stent thrombosis or TLR using treatment modalities other than SES or balloon angioplasty (BA), 1094 lesions with SES-associated restenosis in 990 patients treated with either SES (537 lesions) or BA (557 lesions) constituted the study population for the analysis of recurrent TLR and stent thrombosis after the first TLR. Excluding 24 patients with both SES-and BA-treated lesions, 966 patients constituted the analysis set for the mortality outcome. Cumulative incidence of recurrent TLR in the SES-treated restenosis lesions was significantly lower than that in the BA-treated restenosis lesions (23.8% versus 37.7% at 2 years after the first TLR; PϽ0.0001). Among 33 baseline variables evaluated, only hemodialysis was identified to be the independent risk factor for recurrent TLR by a multivariable logistic regression analysis. After adjusting for confounders, repeated SES implantation was associated with a strong treatment effect in preventing recurrent TLR over BA (odds ratio, 0.44; 95% confidence interval, 0.32 to 0.61; PϽ0.0001). The 2-year mortality and stent thrombosis rates between the SES-and the BA-treated groups were 10.4% versus 10.8% (Pϭ0.4) and 0.6% versus 0.6%, respectively. Conclusions-Repeated implantation of SES for SES-associated restenosis is more effective in preventing recurrent TLR than treatment with BA, without evidence of safety concerns. (Circulation. 2010;122:42-51.
Catheterization and Cardiovascular Interventions, 2004
The purpose of this study was to compare the mid-term clinical outcome of sirolimuseluting stent (SES) implantation and vascular brachytherapy (VBT) for in-stent restenosis (ISR). We assessed the 9-month occurrence of major adverse cardiac events (MACE) in 44 consecutive patients with ISR treated with SES implantation and 43 consecutive patients treated with VBT in the period immediately prior. Baseline clinical and angiographic characteristics of the two groups were similar. During follow-up, three patients (7%) died in the VBT group and none in the SES group. The incidence of myocardial infarction was 2.3% in both groups. Target lesion revascularization was performed in 11.6% of the VBT patients and 16.3% of the SES patients (P ؍ NS). The 9-month MACE-free survival was similar in both groups (79.1% VBT vs. 81.5% SES; P ؍ 0.8 by log rank). The result of this nonrandomized study suggests that sirolimus-eluting stent implantation is at least as effective as vascular brachytherapy in the treatment of in-stent restenosis.
The American Journal of Cardiology, 2006
In patients with in-stent restenosis (ISR) inside bare metal stents, drug-eluting stents reduce the recurrence of restenosis compared with balloon angioplasty. However, few data are available about this therapeutic modality in the case of diffuse restenosis. The aim of this study was to evaluate the immediate and mid-term outcome of sirolimus-and paclitaxel-eluting stent implantation in diffuse ISR and determine the predictors of clinical and angiographic restenosis recurrence. A series of 161 consecutive patients with 194 diffuse ISR lesions (>10 mm) treated with drug-eluting stent implantation were evaluated. Major adverse cardiac events were defined as death, myocardial infarction, and the need for target lesion revascularization. During a mean follow-up of 8.2 ؎ 3.4 months, the cumulative incidence of major adverse cardiac events was 19% in the SES group and 24% in the PES group (p ؍ 0.56). Angiographic follow-up was performed in 80% of the lesions. The overall restenosis rate was 22% and was not significantly different between lesions treated with sirolimus-eluting (20%) or paclitaxel-eluting (25%, p ؍ 0.55) stents. The incidence of restenosis was higher in diabetics (32%) than in nondiabetics (16%, odds ratio 2.5, 95% confidence interval 1.1 to 5.5, p ؍ 0.02). By multivariate analysis, diabetes was confirmed to be the only independent predictor of recurrent restenosis (odds ratio 3.53, 95% confidence interval 1.39 to 9.02, p ؍ 0.008). In conclusion, drug-eluting stent implantation for diffuse ISR is associated with acceptable clinical and angiographic results. The association of diffuse restenosis and diabetes mellitus is an unfavorable condition leading to a high risk of recurrence.