Randomized trial of rotational atherectomy vs balloon angioplasty for in-stent restenosis (ROSTER)

Sharma, Sumeet K.; Kini, Annapoorna; Duvvuri, Srinivas; Sterling, F.D.; Lozano, Íñigo; Dangas, G.; Vidhun, Raghuraman; King, Terry D.; Cocke, Thomas; Marmur, Jonathan D.

doi:10.1016/s0735-1097(98)81260-6

Cited by 7 publications

(12 citation statements)

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“…This difference in the mechanism of lumen enlargement is in agreement with previous studies [7,10,15,17] .…”

Section: Event-free Survival After In-stent Restenosis 759supporting

confidence: 94%

“…This is similar to previous reports of event rates ranging from 14% to 46% after balloon angioplasty, with lesion length being the constant predictive factor of long term outcome [5,7,13] . In studies using rotational atherectomy and balloon angioplasty, clinical event rates between 19% and 35% have been reported, with this rate also depending on the lesion length [7,8,18] . In our study, however, only 13% of patients treated by rotational atherectomy and balloon angioplasty had a clinical event, although admittedly, the average lesion length in our population was relatively short, at only 12·7 7·4 mm.…”

Section: Lesion Length and Clinical Outcomesupporting

confidence: 91%

“…Definitions of these events were the same as those used in previous studies with clinical follow-up after repeat intervention [4][5][6][7][8][9]11,13] .…”

Section: Event-free Survival After In-stent Restenosis 755mentioning

confidence: 99%

“…In addition, favourable late clinical outcome has also been shown after repeat balloon angioplasty in such lesions, with an event rate at 1 year ranging between 8 and 17% [5,6] . Conversely, for non-selected in-stent restenotic lesions, including long (>10 mm) lesions, repeat balloon angioplasty has been shown to result in a high incidence of angiographic restenosis [4,5] or clinical events [3,6,7] , thus prompting the use of alternative therapeutic options like debulking prior to balloon angioplasty, with laser, rotational or directional atherectomy [7][8][9][10][11] . To date, no technique has been shown to be superior.…”

Section: Introductionmentioning

confidence: 99%

“…Intravascular ultrasound imaging allows measurements of the lumen and stent cross-sectional areas and makes it possible to assess the mechanism and result of repeat angioplasty. The mechanism of lumen enlargement after repeat balloon angioplasty is a combination of both stent over-expansion and decrease in neointimal tissue within the stent [13,14] of in-stent restenosis has the potential advantage of achieving larger lumen size post procedure than after balloon angioplasty alone, thanks to a greater decrease in neointimal tissue and less stent over-expansion [7,10,15] . Whether the mechanism of action, i.e.…”

Section: Introductionmentioning

confidence: 99%

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Predictors of event-free survival after repeat intracoronary procedure for in-stent restenosis. Study with angiographic and intravascular ultrasound imaging

Schiele

Méneveau

Seronde

et al. 2000

European Heart Journal

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Aims Lumen enlargement during repeat percutaneous coronary intervention for in-stent restenosis has been shown to be the result of both stent over-expansion and decrease in neointimal tissue. How these two different mechanisms of action may influence outcome and target lesion revascularization after repeat intervention for in-stent restenosis is unclear.Methods Intravascular ultrasound guided repeat intervention for in-stent restenosis was carried out either with balloon angioplasty, or with a combination of rotational atherectomy plus balloon angioplasty. Clinical follow-up at 1 year, including death, myocardial infarction, or need for revascularization, was obtained.Results Seventy patients were included in this study; 40 were treated by balloon alone, and 30 by combination of rotational atherectomy plus balloon. Event-free survival probability was 76 5%. The mechanism of lumen enlargement, be it stent over-expansion or tissue removal, had no influence on long-term clinical evolution. The only independent predictor was the minimal lumen crosssectional area at the end of the procedure, the larger the lumen cross-sectional area, the higher the event-free probability. The cut-off point of the lumen cross-sectional area was set at 4·7 mm 2 by discriminant analysis. Event-free survival was 69 15% in patients with <4·7 mm 2 lumen cross-sectional area and 91 8% in patients with >4·7 mm 2 lumen cross-sectional area (P=0·008).Conclusions This study showed that the only independent predictor of late clinical outcome after percutaneous re-intervention for in-stent restenosis was final lumen size, no matter which means were used to achieve it.

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“…This difference in the mechanism of lumen enlargement is in agreement with previous studies [7,10,15,17] .…”

Section: Event-free Survival After In-stent Restenosis 759supporting

confidence: 94%

Section: Lesion Length and Clinical Outcomesupporting

confidence: 91%

“…Definitions of these events were the same as those used in previous studies with clinical follow-up after repeat intervention [4][5][6][7][8][9]11,13] .…”

Section: Event-free Survival After In-stent Restenosis 755mentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 3 more Smart Citations

Predictors of event-free survival after repeat intracoronary procedure for in-stent restenosis. Study with angiographic and intravascular ultrasound imaging

Schiele

Méneveau

Seronde

et al. 2000

European Heart Journal

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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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Rotational atherectomy or balloon angioplasty in the treatment of intra-stent restenosis: BARASTER Multicenter Registry

Goldberg

Berger

Cohen

et al. 2000

Cathet. Cardiovasc. Intervent.

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The BARASTER registry was formed to evaluate the initial success and long-term results of rotational atherectomy in the management of in-stent restenosis. Rotational atherectomy was used in 197 cases of in-stent restenosis: 46 with stand-alone rotational atherectomy or at most 1 atmosphere of balloon inflation (Rota strategy), and 151 with rotational atherectomy and adjunctive balloon angioplasty <1 atmosphere (Combination strategy). These were compared with 107 episodes of in-stent restenosis treated with balloon angioplasty alone. In this observational study, the use of Combination therapy was associated with a slightly higher initial success rate (95% vs. 87% with the Rota strategy and 89% with Balloons, P = 0.08). There was a reduction in one year clinical outcomes (death, myocardial infarction or target lesion revascularization) in the combination group (38% vs. 60% with Rota and 52% with balloons, P = 0.02). These data support a benefit of the strategy of debulking with rotational atherectomy followed by adjunctive balloon angioplasty, in the management of in-stent restenosis.

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Randomized trial of rotational atherectomy vs balloon angioplasty for in-stent restenosis (ROSTER)

Cited by 7 publications

References 0 publications

Predictors of event-free survival after repeat intracoronary procedure for in-stent restenosis. Study with angiographic and intravascular ultrasound imaging

Predictors of event-free survival after repeat intracoronary procedure for in-stent restenosis. Study with angiographic and intravascular ultrasound imaging

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

Rotational atherectomy or balloon angioplasty in the treatment of intra-stent restenosis: BARASTER Multicenter Registry

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