Clinical and angiographic predictors of recurrent restenosis after percutaneous transluminal rotational atherectomy for treatment of diffuse in-stent restenosis

Dahl, Juergen vom; Radke, Peter W.; Haager, Phillip; Koch, Karl‐Christian; Kastrau, Frank; Reffelmann, Thorsten; Janssens, Uwe; Hanrath, Peter; Klues, Heinrich G.

doi:10.1016/s0002-9149(98)01074-1

Cited by 58 publications

(26 citation statements)

References 23 publications

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“…Importantly, 74% patients were finally asymptomatic at the end of the followup. Our data are in agreement with that of previous studies on long-term outcome after RA for ISR, which showed a restenosis rate of 45%-56% and long-term rates of TVR and CABG of 25%-43% and 6%-12%, respectively [11,13,16].…”

Section: Long-term Results Of Ra For Proximal Lad Isrsupporting

confidence: 93%

“…As in previous studies on RA for ISR [11,13,15,16], the initial angiographic and clinical success rate was very high (100%). It is probable that the previously implanted stent preserves the coronary wall against the vessel damage that both coronary ablation and balloon inflation may produce.…”

Section: Long-term Results Of Ra For Proximal Lad Isrsupporting

confidence: 77%

“…In the study of Sharma et al [11], a burr/artery ratio of Յ 0.6 was associated with higher restenosis rate [11]. Conversely, burr/artery ratio did not predict restenosis in the study of vom Dahl et al [13]. In the present series, a burr/artery ratio Ͼ 0.7 was associated with a slight and nonsignificant lower rate of TVR during follow-up (Fig.…”

Section: Predictors Of Tvr and Angiographic Restenosissupporting

confidence: 39%

“…It is probable that the absence of statistical significance is due to the relatively small sample of patients. Diffuse ISR has been repeatedly associated with a higher rate of restenosis and need of recurrent TVR [11,13,16,20,22].…”

Section: Predictors Of Tvr and Angiographic Restenosismentioning

confidence: 99%

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Long‐term outcome of patients with proximal left anterior descending coronary artery in‐stent restenosis treated with rotational atherectomy

Moreno

Garcı́a

Soriano

et al. 2001

Cathet Cardio Intervent

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Once a first interventional procedure has failed, patients with proximal left anterior descending in-stent restenosis are frequently sent for surgical revascularization. Data on long-term outcome in selected patients with proximal left anterior descending in-stent restenosis treated with RA are lacking. The study's objective was to evaluate the long-term outcome of patients with proximal left anterior descending artery in-stent restenosis treated with rotational atherectomy. The study population is constituted by 42 patients with proximal left anterior descending in-stent restenosis treated with rotational atherectomy. Patients were followed up for 2.1 +/- 0.9 years (range, 6--54). Restenosis length was 16.5 +/- 9.2 mm, and restenosis was diffuse (> 10 mm in length) in 30 (71.4%). The rotational atherectomy procedure was guided by intravascular ultrasound in 18 patients (42.9%). Maximum burr/artery ratio was > 0.7 in 24 (57.1%) patients. One patient suffered a periprocedural non--Q-wave infarction, but no deaths, Q-wave infarction, or new target vessel revascularization occurred during hospitalization. There were no deaths or myocardial infarctions after discharge. Sixteen patients (38.1%) needed a new revascularization, but only five (11.9%) underwent coronary bypass grafting at the end of the follow-up (2.1 +/- 0.9 years). The rate of surgical revascularization at 6 months, 1 year, and 3 years was 4.8%, 7.4%, and 18.4%, respectively. The rate of new target vessel revascularization at 6 months, 1 year, and 3 years was 16.7%, 36.5%, and 40.5%, respectively. Patients with < or = 5 months since stent implantation had a significantly higher rate of new target vessel revascularization. Patients with proximal left anterior descending in-stent restenosis may be safely treated with rotational atherectomy. This strategy is associated with a very good long-term outcome, with few patients undergoing surgical revascularization.

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Section: Long-term Results Of Ra For Proximal Lad Isrsupporting

confidence: 93%

Section: Long-term Results Of Ra For Proximal Lad Isrsupporting

confidence: 77%

Section: Predictors Of Tvr and Angiographic Restenosissupporting

confidence: 39%

Section: Predictors Of Tvr and Angiographic Restenosismentioning

confidence: 99%

See 2 more Smart Citations

Long‐term outcome of patients with proximal left anterior descending coronary artery in‐stent restenosis treated with rotational atherectomy

Moreno

Garcı́a

Soriano

et al. 2001

Cathet Cardio Intervent

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“…Balloon dilation [1,2], laser ablation [3], rotational ablation [4,5], directional atherectomy [6], and restenting [7] all are used; brachytherapy is currently in trial. Despite access to all of these devices, stent restenosis nonetheless is difficult to manage, particularly when a diffuse pattern of in-stent tissue proliferation appears, and often ultimately requires coronary bypass.…”

mentioning

confidence: 99%

Restenting: Should we add a vest to the metal jacket?

Heldman

Brinker

1999

Cathet. Cardiovasc. Intervent.

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Angiographic patterns of in-stent restenosis and implications on subsequent revascularization

Kini

Marmur

Dangas

et al. 2000

Cathet. Cardiovasc. Intervent.

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Stent implantation has become the mainstay of percutaneous revascularization for most coronary lesions; in-stent restenosis (ISR) can occur in 6%-40% of stent procedures and the subsequent response to repeat intervention can possibly be predicted by the angiographic patterns of ISR. This study evaluated the incidence and predictors of angiographic patterns of ISR and its impact on subsequent target lesion revascularization (TLR) in 100 consecutive patients having Palmaz-Schatz ISR undergoing intervention. Diffuse ISR (H10 mm) was observed in 78% and focal ISR (G10 mm) in 22%. Diffuse vs. focal ISR occurred earlier after stent implantation and was more common in diabetics. Angiographic predictors of diffuse ISR were stent implantation for a restenotic lesion, long lesions, smaller vessel, stenting without debulking, and high-pressure balloon inflation (G16 atm). TLR after repeat intervention was 46% for diffuse and 14% for focal ISR (P F 0.02). Rotational atherectomy resulted in lower TLR (31%) vs. PTCA or restent (64%) in diffuse ISR (P F 0.004). Therefore, diffuse ISR is more common than focal ISR, usually occurs in the setting of aggressive intimal hyperplasia, and can be predicted by clinical and angiographic variables. Also, diffuse intimal hyperplasia within a stent responds poorly to PTCA and may benefit from a more aggressive debulking strategy such as rotational atherectomy.

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Clinical and angiographic predictors of recurrent restenosis after percutaneous transluminal rotational atherectomy for treatment of diffuse in-stent restenosis

Cited by 58 publications

References 23 publications

Long‐term outcome of patients with proximal left anterior descending coronary artery in‐stent restenosis treated with rotational atherectomy

Long‐term outcome of patients with proximal left anterior descending coronary artery in‐stent restenosis treated with rotational atherectomy

Restenting: Should we add a vest to the metal jacket?

Angiographic patterns of in-stent restenosis and implications on subsequent revascularization

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