Angiographic Patterns of Drug-Eluting Stent Restenosis and One-Year Outcomes After Treatment With Repeated Percutaneous Coronary Intervention

Solinas, Emilia; Dangas, George; Kirtane, Ajay J.; Lansky, Alexandra J.; Franklin-Bond, Theresa; Boland, Paul; Syros, George; Kim, Young‐Hak; Gupta, Anuj; Mintz, Gary S.; Fahy, Martin; Collins, Michael B.; Kodali, Susheel; Stone, Gregg W.; Moses, Jeffrey W.; Leon, Martin B.; Mehran, Roxana

doi:10.1016/j.amjcard.2008.03.060

Cited by 60 publications

(38 citation statements)

References 12 publications

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“…Although drug-eluting stents (DES) have decreased the incidence of restenosis and repeat revascularization in patients undergoing percutaneous coronary intervention (PCI), excessive antiproliferative effects and hypersensitivity of DES have increased the risk of complicated thrombotic events such as stent thrombosis [1,2,3]. …”

Section: Introductionmentioning

confidence: 99%

A Meta-Analysis of Randomized Controlled Trials Appraising the Efficacy and Safety of Cilostazol after Coronary Artery Stent Implantation

et al. 2012

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Objectives: To evaluate the impact of cilostazol on the angiographic and clinical outcomes in patients undergoing percutaneous coronary intervention (PCI) with stents and treated with aspirin and thienopyridine. Methods: A total of 11 randomized controlled trials including 8,525 patients comparing triple antiplatelet therapy (aspirin, thienopyridine and cilostazol) with standard dual antiplatelet therapy were included in the analysis. The primary end points were in-segment late loss and angiographic restenosis at angiographic follow-up. Secondary end points included mortality, stent thrombosis, target lesion revascularization (TLR) and major adverse cardiac events (MACE). Results: Triple antiplatelet therapy was associated with a significant reduction in late loss [weighted mean difference 0.14, 95% confidence interval (CI) 0.08–0.20; p < 0.001] and angiographic restenosis [odds ratio (OR) 0.58, 95% CI 0.48–0.71; p < 0.001]. Addition of cilostazol to dual antiplatelet therapy was associated with a significant reduction in TLR (OR 0.56, 95% CI 0.41–0.77; p < 0.001) and MACE (OR 0.72, 95% CI 0.60–0.86; p < 0.001) with no differences in mortality (p = 0.29), stent thrombosis (p = 0.60) or bleeding episodes (p = 0.77). Conclusions: Cilostazol in addition to dual antiplatelet therapy appears to be effective in reducing the risk of restenosis and repeat revascularization after PCI without any significant benefits for mortality or stent thrombosis.

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Section: Introductionmentioning

confidence: 99%

A Meta-Analysis of Randomized Controlled Trials Appraising the Efficacy and Safety of Cilostazol after Coronary Artery Stent Implantation

et al. 2012

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“…Similarly, most of the LR patterns of our study were focal. Treatment of DES restenosis was safe and associated with low rate of re-TLR and major adverse cardiac event [19]. Additionally, focal restenosis has a more benign prognosis [11].…”

Section: Discussionmentioning

confidence: 99%

Prediction of late restenosis after sirolimus-eluting stent implantation using serial quantitative angiographic and intravascular ultrasound analysis

Funada

Oikawa

Yajima

et al. 2010

Cardiovasc Interv and Ther

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Although sirolimus-eluting stents (SESs) have shown to significantly reduce the incidence of restenosis, it remains unclear when the follow-up angiography should be performed after SES implantation. A total of 868 patients with 1,574 lesions were treated with SES. Of the 71 patients with 87 lesions were performed serial angiographic and intravascular ultrasound (IVUS) analysis (pre, post, 1st and 2nd-follow-up). The first follow-up period was 7.9 ± 3.5 months and the second follow-up was 18.9 ± 7.7 months. Late restenosis (LR) was defined as diameter stenosis ≥50% at second follow-up, which was <50% at first follow-up. A total of restenosis was documented in 69 patients with 89 lesions (5.7%) overall, 13 lesions (3.2%) led to LR. Angiographic pattern of LR was predominately focal pattern. In LR group, late lumen loss by angiography was increased between 1st-follow-up and 2nd-follow-up (0.69 ± 0.41 mm in first follow-up and 1.98 ± 0.44 mm in second follow-up, p < 0.0001). Minimum lumen area (MLA) by IVUS had slightly decreased already in 1st-follow-up (6.07 ± 2.31 mm(2) in post procedure and 4.71 ± 2.05 mm(2) in 1st-follow-up, p = 0.098) and significantly decreased in 2nd-follow-up (6.07 ± 2.31 mm(2) in post procedure and 1.71 ± 0.93 mm(2) in 2nd-follow-up, p < 0.0001). However, in each period, there were no significant difference in both late lumen loss and MLA in non-LR group. Neointima growth prolonged gradually over 1 year in LR group. These findings suggest that if neointimal proliferation is recognized in short-term-follow-up period, long-follow-up should be needed.

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“…Of note, de novo DES restenosis (ie primary DES restenosis) that were retreated with DES had reasonably better outcomes (recurrent restenosis 18.2% compared with the remaining lesions 70%). Subsequent studies have showed more acceptable results with a rate of target lesion revascularization (TLR) ranging from 8% to 16% [19][20][21][22]24]. However, these studies have had intermediate lengths of follow-up, and most were lacking systematic angiographic follow-up.…”

Section: Outcome After the Treatment Of Des Restenosismentioning

confidence: 99%

Treatment of drug‐eluting stent restenosis: An emerging challenge

Aminian

Kabir

Eeckhout

2009

Cathet Cardio Intervent

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Drug eluting stent (DES) restenosis has emerged as a significant clinical entity owing to the increasing use of DES in complex lesions and patients. However, to date, there is a paucity of studies that have addressed the management of DES restenosis and the resulting outcome, leaving the interventional cardiologist with a therapeutic dilemma. The purpose of this paper is therefore to provide a concise review of available data's dealing with the treatment of DES restenosis, including the outcome of patients treated for DES restenosis, the prognostic importance of the angiographic pattern and the available therapeutic modalities.

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Angiographic Patterns of Drug-Eluting Stent Restenosis and One-Year Outcomes After Treatment With Repeated Percutaneous Coronary Intervention

Cited by 60 publications

References 12 publications

A Meta-Analysis of Randomized Controlled Trials Appraising the Efficacy and Safety of Cilostazol after Coronary Artery Stent Implantation

A Meta-Analysis of Randomized Controlled Trials Appraising the Efficacy and Safety of Cilostazol after Coronary Artery Stent Implantation

Prediction of late restenosis after sirolimus-eluting stent implantation using serial quantitative angiographic and intravascular ultrasound analysis

Treatment of drug‐eluting stent restenosis: An emerging challenge

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