Clinical Coronary In-Stent Restenosis Follow-Up after Treatment and Analyses of Clinical Outcomes

Abstract

BackgroundClinical in-stent restenosis (CISR) is the main limitation of coronary angioplasty with stent implantation.ObjectiveDescribe the clinical and angiographic characteristics of CISR and the outcomes over a minimum follow-up of 12 months after its diagnosis and treatment.MethodsWe analyzed in 110 consecutive patients with CISR the clinical presentation, angiographic characteristics, treatment and combined primary outcomes (cardiovascular death, nonfatal acute myocardial infarction [AMI]) and combined secondary (unstable angina with hospitalization, target vessel revascularization and target lesion revascularization) during a minimal follow-up of one year.ResultsMean age was 61 ± 11 years (68.2% males). Clinical presentations included acute coronary syndrome (ACS) in 62.7% and proliferative ISR in 34.5%. CISR was treated with implantation of drug-eluting stents (DES) in 36.4%, Bare Metal Stent (BMS) in 23.6%, myocardial revascularization surgery in 18.2%, balloon angioplasty in 15.5% and clinical treatment in 6.4%. During a median follow-up of 19.7 months, the primary outcome occurred in 18 patients, including 6 (5.5%) deaths and 13 (11.8%) AMI events. Twenty-four patients presented a secondary outcome. Predictors of the primary outcome were CISR with DES (HR = 4.36 [1.44–12.85]; p = 0.009) and clinical treatment for CISR (HR = 10.66 [2.53–44.87]; p = 0.001). Treatment of CISR with BMS (HR = 4.08 [1.75–9.48]; p = 0.001) and clinical therapy (HR = 6.29 [1.35–29.38]; p = 0.019) emerged as predictors of a secondary outcome.ConclusionPatients with CISR present in most cases with ACS and with a high frequency of adverse events during a medium-term follow-up.

NFAT5 promotes arteriogenesis via MCP‐1‐dependent monocyte recruitment

“…1,2 Well-developed coronary collateral circulation (CCC) is crucial for improving the symptoms and prognosis of CHD patients. 1,2 Well-developed coronary collateral circulation (CCC) is crucial for improving the symptoms and prognosis of CHD patients.…”

Hubungan Lama Implantasi Stent Dengan Kejadian in-Stent Restenosis Bermakna Pada Pasien PJK Yang Dilakukan Angiografi Koroner Evaluasi Di Rumah Sakit Umum Daerah Provinsi Nusa Tenggara Barat

“…[5][6][7][8][9] ISR merupakan tantangan bagi spesialis jantung dan pembuluh darah sebab penyakit ini seringkali terlambat diketahui sebab baru menunjukkan gejala klinis setelah penyempitan lumen mencapai ≥50%. 6,10 Prosedur IKP umumnya menggunakan dua jenis stent, yakni bare metal stent (BMS) atau drug eluting stent (DES). Insidensi ISR dengan stent jenis BMS lebih tinggi dibandingkan dengan stent jenis DES, dengan insidensi ISR pada penggunaan DES menurun menjadi ≤10%.…”

“…Insidensi ISR dengan stent jenis BMS lebih tinggi dibandingkan dengan stent jenis DES, dengan insidensi ISR pada penggunaan DES menurun menjadi ≤10%. [6][7][8]10,11 Waktu yang dibutuhkan sejak pertama kali dilaksanakannya IKP hingga munculnya kejadian ISR sangat bervariasi dan bergantung pada jenis stent yang digunakan dapat dimulai dalam hitungan hari hingga bulan. 12 Kejadian ISR seringkali terlambat diketahui karena ISR baru menimbulkan gejala klinis setelah penyempitan lumen mencapai ≥50%.…”

Microfabrication for Drug Delivery

“…Surgical intervention can be used to clear the blockage and widen the artery, but after surgery the diameter of the artery can narrow again via restenosis, which involves different mechanisms of narrowing from the original atherosclerosis [ 129 ]. One surgical tool is to place stents to prevent elastic rebound, but new cells can grow over the stent during restenosis, forming what is essentially a scar [ 130 ]. However, using techniques from MEMS, drugs can be loaded onto the stents to encourage the arteries to heal in a productive manner [ 131 , 132 ].…”