Treatment of drug‐eluting stent restenosis with the same versus different drug‐eluting stent

Garg, Shuchita; Smith, Kimberly A.; Torguson, Rebecca; Okabe, Teruo; Slottow, Tina L. Pinto; Steinberg, Daniel; Roy, Probal; Zhang, Xue; Gevorkian, Natalie; Satler, Lowell F.; Kent, Kenneth M.; Suddath, William O.; Pichard, Augusto D.; Waksman, Ron

doi:10.1002/ccd.21106

Cited by 56 publications

(56 citation statements)

References 75 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, in the present study, lesion complexity, including quantitative coronary angiography results, was not less than that in previous registries. [4][5][6][7][8] Furthermore, routine angiographic follow-up might be associated with a higher incidence of focal restenosis. However, clinical presentation at follow-up angiography in the present study did not differ between patients with focal and non-focal restenosis.…”

Section: Angiographic Restenosis Pattern After Des Implantationmentioning

confidence: 99%

“…1-10 Large-scale randomized trials 1-3 have demonstrated a high proportion of focal restenosis after DES implantation, but on the other hand, recent real-world registries have shown that a significant proportion of restenosis is non-focal when DES are used in unselected lesions. [4][5][6][7][8] The present study evaluated angiographic patterns of restenosis after sirolimuseluting stent (SES) implantation in real-world practice in Japan. …”

mentioning

confidence: 99%

Angiographic Patterns of Restenosis After Sirolimus-Eluting Stent Implantation

Kitahara

Kobayashi

Takebayashi

et al. 2009

Circ J

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Circ J 2009; 73: 508 -511 lthough drug-eluting stents (DES) have significantly decreased the incidence of restenosis and the need for repeat revascularization, restenosis still occurs. 1-10 Large-scale randomized trials 1-3 have demonstrated a high proportion of focal restenosis after DES implantation, but on the other hand, recent real-world registries have shown that a significant proportion of restenosis is non-focal when DES are used in unselected lesions. [4][5][6][7][8] The present study evaluated angiographic patterns of restenosis after sirolimuseluting stent (SES) implantation in real-world practice in Japan. Methods PatientsA total of 1,693 lesions underwent SES implantation in 3 Japanese hospitals (Chiba University Hospital, Fukuyama Cardiovascular Hospital, and Chiba Cardiovascular Center) between August 2004 and April 2007. PCI was performed after written informed consent was given by the patients. All lesions underwent SES implantation according to current guidelines. 10 Angiographic follow-up was performed in 1,312 lesions (78%) at 6-9 months or earlier if noninvasive evaluation or clinical presentation suggested ischemia. Restenosis occurred in 124 lesions (9.5%) in 122 patients.Using a validated edge detection system (CMS, MEDIS, The Netherlands), quantitative coronary angiography was performed by an experienced cardiologist (H.K.). Standard qualitative and quantitative definitions and measurements were used. The outer diameter of the contrast-filled catheter was used as the calibration and the minimal lumen diameter was obtained from the single "worst" view. Angiographic restenosis was defined as diameter stenosis >50% within a previously stented segment (stent and 5 mm proximal and distal) on follow-up angiography. Cases of stent thrombosis were not considered as restenosis. The angiographic pattern of restenosis was classified as focal (≤10 mm in length), diffuse (restenosis >10 mm within the stent), proliferative (restenosis >10 mm in length extending outside the stent) or occlusive. 11 Focal restenosis was further categorized according to its position as proximal edge, intrastent, distal edge, or multi-focal. This study was approved by the local council on human research. Statistical AnalysisStatistical analysis was performed using StatView 5.0 (SAS Institute, Cary, NC, USA). Continuous variables are expressed as mean ± SD and categorical variables as frequency (%). Continuous variables were compared using Student's t-test. Categorical variables were compared with chi-square statistics; P<0.05 was considered significant.Multivariate logistic regression was used to identify independent predictors of non-focal restenosis. At this stage, the diffuse, proliferative, and occlusive restenosis patterns were combined into a single non-focal group in order to simplify and strengthen subsequent analysis. This was done (Received July 23, 2008; revised manuscript received September 30, 2008; accepted October 20, 2008; released online January 16, 2009 Angiographic Patterns of Restenosis After Sirol...

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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: 67%

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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Treatment of drug‐eluting stent restenosis with the same versus different drug‐eluting stent

Abstract: Reimplantation of DES for the treatment of DES ISR (same or different) is safe but associated with a high rate of recurrences at 1 year regardless of the initial DES type. Other treatment modalities for ISR of DES should be considered to further improve the overall TVR-MACE.

Cited by 56 publications

References 75 publications

Qualitative and Quantitative Assessment of Stent Restenosis by Optical Coherence Tomography

Qualitative and Quantitative Assessment of Stent Restenosis by Optical Coherence Tomography

Angiographic Patterns of Restenosis After Sirolimus-Eluting Stent Implantation

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

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