Re-Restenosis and Target Lesion Revascularization After Treatment of Sirolimus-Eluting Stent Restenosis Retrospective Analysis From 4 Japanese Hospitals

Abstract

Circ J 2009; 73: 867 -871 ecently randomized trials have demonstrated that drug-eluting stents (DES) substantially reduce in-stent restenosis and the need for repeat revascularization compared to bare metal stents. 1,2 However, in-stent restenosis remains an important clinical problem especially in highly complex lesions. 3 There is limited information about the optimal management of DES restenosis. This study evaluated the incidences of angiographic re-restenosis and re-target lesion revascularization (TLR) after the treatment of sirolimus-eluting stent (SES) restenosis. Methods PatientsBetween August 2004 and April 2007, percutaneous coronary intervention (PCI) with SES was performed in 2,300 lesions at 4 Japanese hospitals (Chiba University Hospital, Fukuyama Cardiovascular Hospital, Kimitsu Chuo Hospital, and Chiba Cardiovascular Center). A follow-up angiography was performed in 1,793 lesions (78.0%). Angiographic restenosis was observed in 141 lesions (7.9%). Of these, 102 lesions (4.4%) in 101 patients underwent TLR. This study was approved by the local council on Human Research. DES restenosis was defined as a luminal stenosis of >50% by quantitative coronary angiography located within the stent or within 5 mm of the stent edges. Angiographic patterns of restenosis were classified according to the following scheme: focal (≤10 mm in length), diffuse (restenosis >10 mm within the stent), proliferative (restenosis >10 mm in length extending outside the stent), and occlusive. 4 The diffuse, proliferative, and occlusive restenosis patterns were combined into a non-focal group.PCI was performed after written informed consent was obtained. All patients underwent PCI according to current guidelines. The choice of the PCI devices used was at the operators' discretion. All patients received 100 mg aspirin daily before the procedure and this continued indefinitely. Patients were treated concomitantly with 100 mg ticlopidine twice daily or 50 mg or 75 mg clopidogrel daily for at least 3 months. 5 Angiographic follow up was performed at 9 months or earlier if non-invasive evaluation or clinical presentation suggested ischemia. Focal and non-focal SES restenoses were subclassified according to the use of DES for TLR: (1) focal restenosis treated with DES (focal-DES); (2) focal restenosis treated by conventional balloon angio- (Received September 7, 2008; revised manuscript received December 17, 2008; accepted January 6, 2009; released online April 9, 2009 Re-Restenosis and Target Lesion Revascularization After Treatment of Sirolimus-Eluting Stent Restenosis Retrospective Analysis From 4 Japanese HospitalsHideki Kitahara, MD; Yoshio Kobayashi, MD; Hideo Takebayashi, MD*; Yoshihide Fujimoto, MD**; Yoshitake Nakamura, MD † ; Nakabumi Kuroda, MD; Toshiharu Himi, MD**; Akira Miyazaki, MD † ; Seiichi Haruta, MD*; Issei Komuro, MD Background: There is limited information about optimal management of drug-eluting stent (DES) restenosis. This study evaluated the incidences of re-restenosis and re-target lesion revasculariz...

Long-Term Clinical Results and Predictors of Adverse Outcomes After Drug-Eluting Stent Implantation for Bifurcation Lesions in a Real-World Practice - The COBIS (Coronary Bifurcation Stenting) Registry -

“…The TLR rate at 1 year after sirolimus-eluting stent was only 1.4% in the recent ZEST trial (Park SJ et al, presentation at the late breaking clinical trial session of the American College of Cardiology 58th Annual Scientific Session and i2 Summit), and incidence of definite/probable ST was only 0.91% at 2 years in the j-Cypher registry. 15, 16 Regardless of the cause of variance between the current and previous studies, our registry demonstrates favorable long-term clinical outcomes following DES implantation for the treatment of coronary bifurcation lesions in a real-world practice.…”

Sirolimus-Eluting Stent Versus Balloon Angioplasty for Sirolimus-Eluting Stent Restenosis: Insights From the j-Cypher Registry

“…Focal restenosis was associated with lower incidence of target lesion failure compared with nonfocal restenosis in the case of treatment with bare-metal stent 13 and SES. 8,9 Previous reports demonstrated that focal restenosis remained the most common pattern (71.3% to 79.0%) with SES in real-world clinical practice. 14,15 Although we could not fully address the pattern of restenosis in the current analysis, it is possible that the prevalence of nonfocal restenosis might increase with increasing complexity of the original target lesions.…”

“…For focal restenotic lesions, the incidence of TLR after drug-eluting stent implantation and BA treatment was 8.6% and 11.4%, respectively, whereas for nonfocal restenotic lesions, incidence was 22.6% and 24%, respectively. Kitahara et al 9 reported that in 101 patients with 102 lesions undergoing TLR for SES-associated restenosis, recurrent TLR tended to be lower with SES implantation than with treatment with BA, both in the focal type (12.5% versus 35.5%) and in the nonfocal type (35.3% versus 50.0%), respectively, during the mean follow-up of 13.0Ϯ8.9 months. Angiographic analysis in the present study demonstrated consistent reduction in the rate of recurrent TLR by use of repeated SES implantation in both the focal-type and the nonfocal type SES-associated restenosis.…”

Recurrent In-Stent Restenosis With Total Occlusion Remedied With Drug-Eluting Balloon Angioplasty A Case Report

“…Some studies have shown similar benefits between repeat DES stenting and conventional balloon angioplasty, whereas others have shown clear benefit for repeat DES stenting. [2][3][4] Percutaneous coronary balloon angioplasty has been largely superseded by repeat DES stenting or the 'sandwich stenting' technique, which is steadily gaining prominence. 5) We report a case of recalcitrant target lesion ISR which was successfully treated with drug-eluting balloon deployment.…”