Clinical Outcomes and Treatment After Drug-Eluting Stent Failure

Abstract

Background-The optimal percutaneous treatment of drug-eluting stent (DES) in-stent restenosis (ISR) and the correlates for recurrent DES ISR remain unclear. Methods and Results-From 2003 to 2008, 563 patients presenting with recurrent symptoms of ischemia and angiographic ISR after DES implantation were included. Of these, 327 were treated with re-DES (58.1%), 132 underwent vascular brachytherapy (23.4%), and 104 were treated with conventional balloon angioplasty (18.5%). Variables associated with target lesion revascularization at 1 year were explored by individual proportional hazard models. This population presents a high prevalence of comorbidities, including diabetes (43.7%), previous myocardial infarction (MI) (45.8%), coronary bypass graft surgery (39.2%), chronic renal failure (18.8%), and heart failure (17.3%). Baseline clinical characteristics were balanced among the 3 groups; however, patients undergoing vascular brachytherapy presented with more complex lesions and a higher prevalence of prior stent/vascular brachytherapy failure than did the rest of the population. The overall incidence of recurrent DES failure at 1-year follow-up was 12.2%, which was similar among the 3 groups (Pϭ0.41). The rate of the composite end point (death, Q-wave-MI and target lesion revascularization) at 1-year follow-up was 14.1% for re-DES, 17.5% for vascular brachytherapy, and 18.0% for conventional balloon angioplasty (Pϭ0.57). After univariable analysis tested the traditional known covariates related to ISR, none of them were associated with repeat target lesion revascularization. Conclusions-Recurrence of ISR after DES treatment failure is neither infrequent nor benign, and optimal therapy remains unclear and challenging. Given the absence of traditional risk factors for ISR in this population, further research is required to elucidate both the correlates involved in DES ISR and the optimal treatment for this condition. (Circ Cardiovasc Interv. 2012;5:12-19.)

Long‐term outcome of brachytherapy treatment for coronary in‐stent restenosis: Ten‐year follow‐up

“…The “late catch up” phenomenon has been used to describe late luminal loss due to intimal hyperplasia . This phenomenon is usually seen after 6 months to 1 year post‐ICBT, attributing to the high incidence of TVR . TVR rates have been reported to be as high as 5.8% per year at 5‐year follow‐up with one study showing no significant difference in TLR at 5‐year follow‐up between ICBT and DES …”

“…17 This phenomenon is usually seen after 6 months to 1 year post-ICBT, attributing to the high incidence of TVR. 17,18 TVR rates have been reported to be as high as 5.8% per year at 5-year follow-up with one study showing no significant difference in TLR at 5-year follow-up between ICBT and DES. 7,16 There have been many studies directly comparing DES and ICBT for treatment of BMS-ISR, most of which had ≤5-year follow-up.…”

Intracoronary Imaging and Histopathology of Late Phase In-Stent Restenosis after Coronary Stent Implantation

“…Paclitaxel-coated balloon angioplasty is not inferior to paclitaxel-eluting stents for BMS restenosis [29]. In ISR after DES implantation, a couple of studies have been conducted [24,30,31]. It should be determined whether same or the other DES is more beneficial in preventing recurrence of ISR.…”

Laminin Receptor-Avid Nanotherapeutic EGCg-AuNPs as a Potential Alternative Therapeutic Approach to Prevent Restenosis

“…Delayed endothelial healing renders the artery vulnerable to blood clot formation (thrombosis), which can abruptly obstruct blood flow and cause myocardial infarction [ 42 ]. Recent clinical trials in patients treated with drug-eluting stents (DES) confirm the failure of this cardiovascular treatment modality in a significant percentage of patients [ 43 ]. DES have been linked to severe risks of blood clots which could develop months or even years after the stent is implanted [ 44 ].…”

“…Several clinical investigations have concluded that approximately one out of every 200 patients who receive a DES will experience a blood clot between six months and four years after the stent is implanted. Prior studies of late stent thrombosis show that these blood clots lead to a major heart attack or death approximately 70% of the time, with a fatality rate of 30% to 45% [ 43 ].…”