Circ J 2009; 73: 867 -871 ecently randomized trials have demonstrated that drug-eluting stents (DES) substantially reduce in-stent restenosis and the need for repeat revascularization compared to bare metal stents. 1,2 However, in-stent restenosis remains an important clinical problem especially in highly complex lesions. 3 There is limited information about the optimal management of DES restenosis. This study evaluated the incidences of angiographic re-restenosis and re-target lesion revascularization (TLR) after the treatment of sirolimus-eluting stent (SES) restenosis.
Methods
PatientsBetween August 2004 and April 2007, percutaneous coronary intervention (PCI) with SES was performed in 2,300 lesions at 4 Japanese hospitals (Chiba University Hospital, Fukuyama Cardiovascular Hospital, Kimitsu Chuo Hospital, and Chiba Cardiovascular Center). A follow-up angiography was performed in 1,793 lesions (78.0%). Angiographic restenosis was observed in 141 lesions (7.9%). Of these, 102 lesions (4.4%) in 101 patients underwent TLR. This study was approved by the local council on Human Research. DES restenosis was defined as a luminal stenosis of >50% by quantitative coronary angiography located within the stent or within 5 mm of the stent edges. Angiographic patterns of restenosis were classified according to the following scheme: focal (≤10 mm in length), diffuse (restenosis >10 mm within the stent), proliferative (restenosis >10 mm in length extending outside the stent), and occlusive. 4 The diffuse, proliferative, and occlusive restenosis patterns were combined into a non-focal group.PCI was performed after written informed consent was obtained. All patients underwent PCI according to current guidelines. The choice of the PCI devices used was at the operators' discretion. All patients received 100 mg aspirin daily before the procedure and this continued indefinitely. Patients were treated concomitantly with 100 mg ticlopidine twice daily or 50 mg or 75 mg clopidogrel daily for at least 3 months. 5 Angiographic follow up was performed at 9 months or earlier if non-invasive evaluation or clinical presentation suggested ischemia. Focal and non-focal SES restenoses were subclassified according to the use of DES for TLR: (1) focal restenosis treated with DES (focal-DES); (2) focal restenosis treated by conventional balloon angio- (Received September 7, 2008; revised manuscript received December 17, 2008; accepted January 6, 2009; released online April 9, 2009
Re-Restenosis and Target Lesion Revascularization After Treatment of Sirolimus-Eluting Stent Restenosis Retrospective Analysis From 4 Japanese HospitalsHideki Kitahara, MD; Yoshio Kobayashi, MD; Hideo Takebayashi, MD*; Yoshihide Fujimoto, MD**; Yoshitake Nakamura, MD † ; Nakabumi Kuroda, MD; Toshiharu Himi, MD**; Akira Miyazaki, MD † ; Seiichi Haruta, MD*; Issei Komuro, MD Background: There is limited information about optimal management of drug-eluting stent (DES) restenosis. This study evaluated the incidences of re-restenosis and re-target lesion revasculariz...