Predictive Factors for Restenosis after Drug-Eluting Stent Implantation

Abstract

Background and Objectives：Despite the dramatic reduction in restenosis conferred by drug-eluting stents (DES), restenosis remains a significant problem for real-world patients. Restenosis is a complex phenomenon, and a variety of stent-, drug-, patient-and lesion-related factors have been studied as the determinants of restenosis after DES implantation. Methods and Results：The stent delivery system, the polymer and the drug are integral components of DES, and these are the device-specific factors that can affect restenosis. While the sirolimuseluting Cypher stent appears to provide better outcomes than the paclitaxel-eluting Taxus stent in high-risk patient groups with complex lesions, such differences between the two DES are not apparent in the low-risk groups. Diabetic patients are generally prone to restenosis after percutaneous coronary intervention, but there are conflicting findings regarding the impact of diabetes mellitus on restenosis after DES implantation. The postintervention final lumen area continues to be the most important determinant of restenosis after DES implantation, indicating that a greater stented area contributes to a decreased rate of restenosis even in the DES era. Nonuniform strut distribution and stent fracture also contribute to the development of restenosis after DES implantation. In addition, the risk of restenosis increases linearly according to lesion length, and a "full metal jacket" approach in small vessels is related to a high risk of DES failure. Conclusion：Small vessel disease, diffuse disease and the type of DES are important predictors of restenosis after DES implantation. However, predicting restenosis remains difficult, and this indicates the need for further studies in order to ultimately identify those patients who are at high risk for DES failure.

Recurrent Event Analysis of Coronary Artery Stenosis in Patients Undergoing Angioplasty

“…In this study, the effect of the history of diabetes was significant on restenosis; it is similar to many previously conducted studies (19)(20)(21). However, some studies argued that the effect of diabetes was not significant on restenosis (22,23). The observed difference in the results can be attributed to the low prevalence of diabetes in the present study.…”

Multiple Sequential Complications After Sirolimus-Eluting Stent Implantation: Very Late Stent Thrombosis, Stent Fracture, In-Stent Restenosis, and Peri-Stent Aneurysm

“… 9) Additional risk factors for ISR include diabetes, lesion length, luminal cross-sectional area after stenting, the number and length of stents, and the plaque burden. 10 - 14) We found in a previous study that stent fracture may be another potential risk factor for ISR. 6) The patient reported here had diabetes, and stent under expansion was not observed after stent implantation.…”

“…The mechanism responsible for restenosis is associated with neointimal formation 9). Additional risk factors for ISR include diabetes, lesion length, luminal cross-sectional area after stenting, the number and length of stents, and the plaque burden 10-14). We found in a previous study that stent fracture may be another potential risk factor for ISR 6).…”

Analysis of Potential Cost-Savings After Introduction of Drug-Eluting Balloon Angioplasty for In-Stent Restenosis or Small Vessel Disease

“…The complex, vexing problem of restenosis after balloon angioplasty is influenced by a variety of clinical and anatomic factors. Vessel size is an important anatomic factor, 17) and in fact, restenosis rate is inversely related to vessel diameter. 18) It has been reported that angiographic and clinical outcomes after balloon angioplasty and elective stent placement are best in vessels slightly smaller than 3 mm, 19) and regarding the treatment of stenotic coronary arteries with diameters below 3 mm, previous studies have demonstrated the superiority of implanting DES for restenosis reduction as compared to BMS implantation in SVD.…”