Registry Data Evaluating the Effectiveness of Drug-eluting Stents for the Treatment of Symptomatic In-stent Restenosis

• Published in: Heart, lung & circulation lung & circulation, 2006-10, Vol.15 (5), p.300-305
• Main Authors: Worthley, Matthew I., Anderson, Todd J., Traboulsi, Mouhieddin, Charbonneau, Francois, Curtis, Michael J., Hansen, James L., Knudtson, Merril L., Spence, Frank P., Goodhart, David M.
• Format: Article
• Language: English
• Subjects: Antineoplastic Agents, Phytogenic - pharmacology; Blood Vessel Prosthesis Implantation - instrumentation; Coated Materials, Biocompatible; Coronary Angiography; Coronary Restenosis - diagnostic imaging; Coronary Restenosis - surgery; Drug-eluting stents; Female; Follow-Up Studies; Humans; Immunosuppressive Agents - pharmacology; In-stent restenosis; Male; Middle Aged; Paclitaxel; Paclitaxel - pharmacology; Prosthesis Failure; Reoperation; Retrospective Studies; Sirolimus; Sirolimus - pharmacology; Stents; Time Factors; Treatment Outcome
• ISSN: 1443-9506; 1444-2892
• DOI: 10.1016/j.hlc.2006.06.002

In this new-era of drug-eluting stents (DES) the impact of symptomatic in-stent restenosis (ISR) is diminishing. However, world wide bare-metal stents remain widely used and therefore, it is imperative to establish a simple and effective form of treatment. The objective of this registry database was to evaluate the ‘real-world’ effectiveness of DES for the treatment of symptomatic bare-metal stent ISR. All patients presenting with symptomatic ISR were evaluated between February 2003 and February 2005. Patients had 9-month angiographic follow-up with primary endpoint evaluation of binary restenosis (>50%). Secondary endpoints included in-segment late loss, target lesion revascularization (TLR) and the difference in late loss between sirolimus ( n = 23) and paciltaxel ( n = 36) eluting stents. Fifty eight patients with fifty nine ISR lesions were evaluated, 36% of patients had diabetes mellitus. All procedures were performed safely with no adverse peri-procedural events documented. At 9-month follow-up the median in-segment late loss was 0.24 mm (IQR 0.1, 0.53), with a binary restenosis rate of 17%. At long-term follow-up greater than 1 year, the incidence of TLR was 10%. No difference in the angiographic parameter of in-segment late loss was seen between the sirolimus and paclitaxel-eluting stents. In this cohort of patients with long-term angiographic and clinical follow-up, DES is an effective and safe treatment for symptomatic bare-metal stent ISR.