Routine sirolimus eluting stent implantation for unselected in-stent restenosis: insights from the rapamycin eluting stent evaluated at Rotterdam cardiology hospital (RESEARCH) registry

• Published in: Heart (British Cardiac Society) 2004-10, Vol.90 (10), p.1183-1188
• Main Authors: Saia, F, Lemos, P A, Arampatzis, C A, Hoye, A, Degertekin, M, Tanabe, K, Sianos, G, Smits, P C, van der Giessen, W J, de Feyter, P J, van Domburg, R T, Serruys, P W
• Format: Article
• Language: English
• Subjects: Acute coronary syndromes; Aged; Antibacterial agents; Antibiotics. Antiinfectious agents. Antiparasitic agents; Biological and medical sciences; Cardiology; Cardiology. Vascular system; Coronary Angiography; Coronary Restenosis - diagnostic imaging; Coronary Restenosis - mortality; Coronary Restenosis - therapy; Coronary vessels; drug eluting stent; Drug Implants; Female; Follow-Up Studies; Heart attacks; Humans; Immunosuppressive Agents - therapeutic use; in-stent restenosis; Interventional Cardiology and Surgery; Male; Medical sciences; Middle Aged; Pharmacology. Drug treatments; Prospective Studies; Radiation therapy; rapamycin eluting stents evaluated at Rotterdam cardiology hospital; SES; sirolimus; Sirolimus - therapeutic use; sirolimus eluting stent; Stents; Studies; thrombolysis in myocardial infarction; TIMI; Veins & arteries
• ISSN: 1355-6037; 1468-201X
• DOI: 10.1136/hrt.2003.025536

Objective: To assess the effectiveness of routine sirolimus eluting stent (SES) implantation for unselected patients with in-stent restenosis and to provide preliminary information about the angiographic outcome for lesion subgroups and for different in-stent restenosis patterns. Design: Prospective, single centre registry. Setting: Tertiary referral centre. Patients: 44 consecutive patients (53 lesions) without previous brachytherapy who were treated with SES for in-stent restenosis were evaluated. Routine angiographic follow up was obtained at six months and the incidence of major adverse cardiovascular events was evaluated. Results: At baseline, 42% of the lesions were focal, 21% diffuse, 26% proliferative, and 11% total occlusions. Small vessel size (reference diameter ⩽ 2.5 mm) was present in 49%, long lesions (> 20 mm) in 30%, treatment of bypass grafts in 13%, and bifurcation stenting in 18%. At follow up, post-SES restenosis was observed in 14.6%. No restenosis was observed in focal lesions. For more complex lesions, restenosis rates ranged from 20–25%. At the one year follow up, the incidence of death was 0, myocardial infarction 4.7% (n  =  2), and target lesion revascularisation 16.3% (n  =  7). The target lesion was revascularised because of restenosis in 11.6% (n  =  5). Conclusions: Routine SES implantation is highly effective for focal in-stent restenosis and appears to be a promising strategy for more complex patterns of restenosis.