Repeated drug-eluting stent implantation for drug-eluting stent restenosis: The same or a different stent

Cosgrave, John; Melzi, Gloria; Corbett, Simon; Biondi‐Zoccai, Giuseppe; Babic, Rade; Airoldi, Flavio; Chieffo, Alaide; Sangiorgi, Giuseppe; Montorfano, Matteo; Michev, Iassen; Carlino, Mauro; Colombo, Antonio

doi:10.1016/j.ahj.2006.12.009

Cited by 78 publications

(90 citation statements)

References 21 publications

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“…[33][34][35] Because there is currently no effective recommended treatment for such cases, simple balloon dilatation of restenotic tissue could be a major treatment strategy. Therefore, we examined the response to BA of vessels in ISR lesions based on OCT.…”

Section: Response To Ba In Isr Lesionsmentioning

confidence: 99%

Qualitative and Quantitative Assessment of Stent Restenosis by Optical Coherence Tomography

Nagoshi

Shinke

Otake

et al. 2013

Circ J

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Section: Response To Ba In Isr Lesionsmentioning

confidence: 99%

Qualitative and Quantitative Assessment of Stent Restenosis by Optical Coherence Tomography

Nagoshi

Shinke

Otake

et al. 2013

Circ J

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“…However, this hypothesis has not been proved in clinical observation. Garg et al (2007), Cosgrave et al (2007b), and Sardella et al (2009) reported, respectively, a similar prognosis between homo-DES and hetero-DES strategies in the treatment of DES-ISR. In our study, there was a trend toward lower MACE rates in the DES-ISR patients using a different type of DES, but it did not reach statistical significance.…”

Section: Discussionmentioning

confidence: 66%

Efficacy and safety of drug-eluting stent implantation for the treatment of in-stent restenosis occurring within bare-metal stent and drug-eluting stent

Zhang

Zhou

et al. 2010

J. Zhejiang Univ. Sci. B

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Abstract:Objective: Although drug-eluting stent (DES) implantation is the primary treatment modality for bare-metal stent (BMS) in-stent restenosis (ISR), little is known about the efficacy and safety profile of DES in the treatment of DES-ISR. The goal of this study was to compare the clinical outcomes following DES treatment for BMS-ISR and DES-ISR. Methods: Rates of major adverse cardiac events (MACE) were compared in 97 consecutive patients who underwent DES implantation for the treatment of ISR (56 BMS-ISR and 41 DES-ISR) from January 2004 to December 2008. Results: Baseline clinical and procedural characteristics were comparable, except that the DES used in the BMS-ISR group was longer and had a larger diameter. The length of follow-up was (28.60±1.96) and (20.34±1.54) months for the BMS-ISR and DES-ISR groups, respectively. One patient (1.8%) experienced non-cardiac mortality and one (1.8%) had target-vessel revascularization (TVR) in the BMS-ISR group. In the DES-ISR group, three patients (7.3%) died of sudden death with a documented acute ST-segment elevation myocardial infarction, and three suffered TVR (7.3%). Kaplan-Meier analysis indicated that cumulative survival probability and MACE-free probability were both significantly lower for the DES-ISR group (log rank test P=0. 047 and P=0.005, respectively). In Cox regression analysis, DES-ISR remained an independent predictor for future MACE occurrence after adjustment for other factors (compared with BMS-ISR, risk ratio (RR)=8.743, 95% confidence interval (CI) 1. 54-49.54, P=0.014). Switching to a different type of DES to treat DES-ISR did not improve the prognosis. Conclusion: DES-ISR patients had a poorer prognosis than BMS-ISR patients after DES therapy.

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“…As previously reported, regardless of the treatment modality used, the rate of cardiovascular events and TLR in such a complex population is expected to be high. [13][14][15] Different mechanisms have been enunciated as possible etiologies for recurrent DES failure. On one hand, mechanical factors, such as stent underexpansion or strut fracture, have been linked to stent failure.…”

Section: Discussionmentioning

confidence: 99%

Clinical Outcomes and Treatment After Drug-Eluting Stent Failure

Maluenda

Ben‐Dor

Gaglia

et al. 2012

Circ: Cardiovascular Interventions

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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.)

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Repeated drug-eluting stent implantation for drug-eluting stent restenosis: The same or a different stent

Cited by 78 publications

References 21 publications

Qualitative and Quantitative Assessment of Stent Restenosis by Optical Coherence Tomography

Qualitative and Quantitative Assessment of Stent Restenosis by Optical Coherence Tomography

Efficacy and safety of drug-eluting stent implantation for the treatment of in-stent restenosis occurring within bare-metal stent and drug-eluting stent

Clinical Outcomes and Treatment After Drug-Eluting Stent Failure

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