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Madanat L, Donisan T, Balanescu DV, Jabri A, Al-Abdouh A, Alsabti S, Li S, Kheyrbek M, Mertens A, Hanson I, Dixon S. The contemporary use of intracoronary brachytherapy for instent restenosis: A review. CARDIOVASCULAR REVASCULARIZATION MEDICINE 2023; 51:67-74. [PMID: 36732133 DOI: 10.1016/j.carrev.2023.01.019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2022] [Revised: 01/14/2023] [Accepted: 01/24/2023] [Indexed: 01/31/2023]
Abstract
In-stent restenosis (ISR) has been a major limitation in interventional cardiology and constitutes nearly 10 % of all percutaneous coronary interventions in the United States. Drug-eluting stent (DES) restenosis proves particularly difficult to manage and poses a high risk of recurrence and repeat intervention. Intra-coronary brachytherapy (IBT) has been traditionally viewed as a potential treatment modality for ISR. However, its use was hindered by procedural complexity, cost, and the advent of newer-generation DES. Recent data suggests promising results regarding IBT for the treatment of resistant DES-ISR. This review addresses the mechanism of action of IBT, procedural details, and associated risks and complications of its use. It will also highlight the available clinical evidence supporting the use of IBT and the future directions of its utilization in the treatment of ISR.
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Affiliation(s)
- Luai Madanat
- Department of Internal Medicine, Beaumont Hospital, Royal Oak, MI, United States of America.
| | - Teodora Donisan
- Department of Cardiovascular Medicine, Mayo Clinic School of Medicine, Rochester, MN, United States of America
| | - Dinu V Balanescu
- Department of Internal Medicine, Beaumont Hospital, Royal Oak, MI, United States of America
| | - Ahmad Jabri
- Department of Cardiovascular Medicine, Heart and Vascular Center, Metrohealth Medical Center, Cleveland, OH, United States of America
| | - Ahmad Al-Abdouh
- Department of Internal Medicine, University of Kentucky, Lexington, KY, United States of America
| | - Sam Alsabti
- Department of Internal Medicine, Beaumont Hospital, Royal Oak, MI, United States of America
| | - Shuo Li
- Department of Internal Medicine, Beaumont Hospital, Royal Oak, MI, United States of America
| | - Mazhed Kheyrbek
- Department of Internal Medicine, Beaumont Hospital, Royal Oak, MI, United States of America
| | - Amy Mertens
- Department of Cardiovascular Medicine, Beaumont Hospital, Royal Oak, MI, United States of America
| | - Ivan Hanson
- Department of Cardiovascular Medicine, Beaumont Hospital, Royal Oak, MI, United States of America
| | - Simon Dixon
- Department of Internal Medicine, University of Kentucky, Lexington, KY, United States of America
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Donisan T, Madanat L, Balanescu DV, Mertens A, Dixon S. Drug-Eluting Stent Restenosis: Modern Approach to a Classic Challenge. Curr Cardiol Rev 2023; 19:e030123212355. [PMID: 36597603 PMCID: PMC10280993 DOI: 10.2174/1573403x19666230103154638] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/13/2022] [Revised: 11/19/2022] [Accepted: 11/21/2022] [Indexed: 01/05/2023] Open
Abstract
In-stent restenosis (ISR) is a recognized complication following percutaneous coronary intervention in which the luminal diameter is narrowed through neointimal hyperplasia and vessel remodeling. Although rates of ISR have decreased in most recent years owing to newer generation drug-eluting stents, thinner struts, and better intravascular imaging modalities, ISR remains a prevalent dilemma that proves to be challenging to manage. Several factors have been proposed to contribute to ISR formation, including mechanical stent characteristics, technical factors during the coronary intervention, and biological aspects of drug-eluting stents. Presentation of ISR can range from asymptomatic to late myocardial infarction and could be difficult to differentiate from acute thrombus formation. No definite guidelines are present on the management of ISR. In this review, we will discuss the mechanisms underlying ISR and provide insight into patient-related and procedural risk factors contributing to ISR, in addition to highlighting common treatment approaches utilized in the management of ISR.
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Affiliation(s)
- Teodora Donisan
- Department of Internal Medicine, Beaumont Hospital, Royal Oak, MI, 48073, USA
| | - Luai Madanat
- Department of Internal Medicine, Beaumont Hospital, Royal Oak, MI, 48073, USA
| | - Dinu V. Balanescu
- Department of Internal Medicine, Beaumont Hospital, Royal Oak, MI, 48073, USA
| | - Amy Mertens
- Department of Cardiovascular Medicine, Beaumont Hospital, Royal Oak, MI, 48073, USA
| | - Simon Dixon
- Department of Cardiovascular Medicine, Beaumont Hospital, Royal Oak, MI, 48073, USA
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Combined Vascular Brachytherapy and Stenting for the Treatment of In-Stent Restenosis. Am J Cardiol 2020; 125:712-719. [PMID: 31889523 DOI: 10.1016/j.amjcard.2019.11.035] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/29/2019] [Revised: 11/21/2019] [Accepted: 11/25/2019] [Indexed: 11/20/2022]
Abstract
In-stent restenosis (ISR) remains a therapeutic challenge in the current drug-eluting stent (DES) era. Vascular brachytherapy (VBT) is a therapeutic option for ISR, but data about the outcomes of combination therapy with VBT and stenting for ISR lesions are sparse. We retrospectively analyzed patients who presented with ISR at our institution from 2003 through 2017. Three treatment arms were compared: VBT alone, VBT plus bare-metal stent (BMS), and VBT plus DES. Clinical, procedural, and 1-year outcome data were collected. Follow-up was obtained by phone calls and clinic visits. The patient cohort included 461 patients (764 ISR lesions). Of these, 333 patients (533 lesions) were treated with VBT alone, 89 patients (158 lesions) with VBT plus BMS, and 39 patients (73 lesions) with VBT plus DES. There were no significant differences in baseline characteristics among the 3 groups except for more patients with a remote smoking history in the VBT plus BMS (43.8%) and VBT plus DES groups (56.4%), and more patients with history of peripheral vascular disease (39.5%) and congestive heart failure (27%) in the VBT plus DES group. The most common clinical presentation was unstable angina (64.6%). In the VBT plus DES group, 10.3% of patients presented with MI, versus 5.5% in the VBT alone group and 2.2% in the VBT plus BMS group. At 1-year follow-up, the VBT plus DES group had higher rates of target vessel revascularization-major adverse cardiovascular events (38.5%) than the VBT plus BMS (21.3%) and VBT alone (15.6%) groups (p = 0.002). In conclusion, in patients with ISR, combination therapy with VBT and stenting at the same setup is associated with worse outcomes at 12 months and, if possible, should be avoided.
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Alraies MC, Darmoch F, Tummala R, Waksman R. Diagnosis and management challenges of in-stent restenosis in coronary arteries. World J Cardiol 2017; 9:640-651. [PMID: 28932353 PMCID: PMC5583537 DOI: 10.4330/wjc.v9.i8.640] [Citation(s) in RCA: 46] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/03/2016] [Revised: 05/27/2017] [Accepted: 07/17/2017] [Indexed: 02/06/2023] Open
Abstract
Over the course of the 3 decades, percutaneous coronary intervention (PCI) with stent implantation transformed the practice of cardiology. PCI with stenting is currently the most widely performed procedure for the treatment of symptomatic coronary disease. In large trials, drug-eluting stents (DES) have led to a significant reduction in in-stent restenosis (ISR) rates, one of the major limitations of bare-metal stents. Due to these favorable findings, DES was rapidly and widely adopted enabling more complex coronary interventions. Nevertheless, ISR remains a serious concern as late stent complications. ISR mainly results from aggressive neointimal proliferation and neoatherosclerosis. DES-ISR treatment continues to be challenging complications for interventional cardiologists.
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Affiliation(s)
- M Chadi Alraies
- Heart and Vascular Institute, Department of Interventional Cardiology, Georgetown University/MedStar Washington Hospital Center, Washington, DC 20010, United States
| | - Fahed Darmoch
- Internal Medicine Department, St Vincent Charity Medical Center/Case Western Reserve University, Cleveland, OH 44115, United States
| | - Ramyashree Tummala
- Internal Medicine Department, St Vincent Charity Medical Center/Case Western Reserve University, Cleveland, OH 44115, United States
| | - Ron Waksman
- Heart and Vascular Institute, Department of Interventional Cardiology, Georgetown University/MedStar Washington Hospital Center, Washington, DC 20010, United States
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Hong SJ, Ahn CM, Kim BK, Ko YG, Hur SH, Yu CW, Lee SJ, Choi CU, Kim JS, Yoon JH, Hong YJ, Choi JW, Choi SH, Jang Y, Lim DS. Prospective randomized comparison of clinical and angiographic outcomes between everolimus-eluting vs. zotarolimus-eluting stents for treatment of coronary restenosis in drug-eluting stents: intravascular ultrasound volumetric analysis (RESTENT-ISR trial). Eur Heart J 2016; 37:3409-3418. [PMID: 27634828 DOI: 10.1093/eurheartj/ehw389] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/29/2015] [Revised: 06/24/2016] [Accepted: 08/15/2016] [Indexed: 12/21/2022] Open
Abstract
AIMS At present no proven standard treatment for drug-eluting stent (DES) restenosis is available, and the efficacy and safety of everolimus-eluting stent (EES) and zotarolimus-eluting stent (ZES) for DES restenosis are limited. The purpose of this prospective, randomized 9-month intracoronary ultrasound (IVUS) and 3-year clinical follow-up study was to compare the effects of EESs and ZESs on neointima volume and major adverse cardiovascular events (MACEs) such as death, myocardial infarction (MI), target lesion revascularization (TLR) and stent thrombosis in DES restenosis patients. METHODS AND RESULTS Patients were eligible for this study if they were between 40 and 75 years old with in-stent restenosis >50% by quantitative coronary angiographic analysis in DES or within 5 mm of the stent edges with signs of ischaemia. Eligible patients (n = 304, 146 women and 158 men) were randomly assigned to receive either EES (158 patients) or ZES (146 patients). The primary endpoint of the study was to compare neointima volume between the EES and ZES groups at the 9-month follow-up IVUS. MACEs, including death, non-fatal MI, stent thrombosis and the need for repeated TLR within 3 years, were noted. The 9-month angiographic and IVUS follow-up showed no significant differences in late lumen loss (0.40 ± 0.56 vs. 0.45 ± 0.61 mm, P = 0.57, respectively) and neointima volume (0.51 ± 0.48 vs. 0.56 ± 0.54 mm3/1 mm, P = 0.47, respectively) in the EES and the ZES groups. Composite MACEs such as death, MI, stent thrombosis and TLR during 3-year follow-up were comparable between the two groups [15.8% (n = 25) in the EES group and 22.6% (n = 33) in the ZES group, P = 0.276], independent of de novo DES type, sex, age, body mass index, presence of diabetes, hypertension and dyslipidaemia. CONCLUSIONS Patients with first- and second-generation DES restenosis, both EES and ZES implantation were effective and safe in reducing neointima volume and late loss with a comparable rate of MACEs independent of cardiovascular risk factors.
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Affiliation(s)
- Soon Jun Hong
- Department of Cardiology, Cardiovascular Center, Korea University Anam Hospital, 126-1, 5ka, Anam-dong, Sungbuk-ku, Seoul 136-705, Korea
| | - Chul Min Ahn
- Department of Cardiology, Cardiovascular Center, Korea University Anam Hospital, 126-1, 5ka, Anam-dong, Sungbuk-ku, Seoul 136-705, Korea.,Severance Cardiovascular Hospital, Yonsei University, 50-1, Yonsei-ro, Seodaemun-gu, Seoul 120-752, Korea
| | - Byeong-Keuk Kim
- Severance Cardiovascular Hospital, Yonsei University, 50-1, Yonsei-ro, Seodaemun-gu, Seoul 120-752, Korea
| | - Young-Guk Ko
- Severance Cardiovascular Hospital, Yonsei University, 50-1, Yonsei-ro, Seodaemun-gu, Seoul 120-752, Korea
| | - Seung-Ho Hur
- Keimyung University Dongsan Medical Center, 56 Dalseong-Ro, Jung-Gu, Daegu 700-712 Korea
| | - Cheol Woong Yu
- Department of Cardiology, Cardiovascular Center, Korea University Anam Hospital, 126-1, 5ka, Anam-dong, Sungbuk-ku, Seoul 136-705, Korea
| | - Seung-Jin Lee
- Soonchunhyang University Medical Center, 23-20, Byeongmyeong-dong, Dongnam-gu, Cheonan, Chungcheongnam-do 31151, Korea
| | - Cheol Ung Choi
- Korea University Guro Hospital, 148, Gurodong-ro, Guro-gu, Seoul 08308, Korea
| | - Je Sang Kim
- Sejong General Hospital, Sosabon-dong, Sosa-gu, Bucheon-si, Gyeonggi-do 14754, Korea
| | - Jung-Han Yoon
- Yonsei University Wonju College of Medicine, Wonju Christian Hospital, 20 Ilsan-ro, Wonju, Gangwon-do, Wonju 220-701, Korea
| | - Young Joon Hong
- Chonnam National University Hospital, 77 Yongbong-ro, Buk-gu, Gwangju 500-757, Korea
| | - Jae-Woong Choi
- Eulji General Hospital, 68 Hangeulbiseok-Ro, Nowon-Gu, Seoul 01830, Korea
| | - Seung-Hyuk Choi
- Samsung Medical Center, Sungkyunkwan University School of Medicine, 81 Irwon-ro, Gangnam-gu, Seoul 06351, Korea
| | - Yangsoo Jang
- Severance Cardiovascular Hospital, Yonsei University, 50-1, Yonsei-ro, Seodaemun-gu, Seoul 120-752, Korea
| | - Do-Sun Lim
- Department of Cardiology, Cardiovascular Center, Korea University Anam Hospital, 126-1, 5ka, Anam-dong, Sungbuk-ku, Seoul 136-705, Korea
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Negi SI, Torguson R, Gai J, Kiramijyan S, Koifman E, Chan R, Randolph P, Pichard A, Satler LF, Waksman R. Intracoronary Brachytherapy for Recurrent Drug-Eluting Stent Failure. JACC Cardiovasc Interv 2016; 9:1259-1265. [PMID: 27339842 DOI: 10.1016/j.jcin.2016.03.018] [Citation(s) in RCA: 44] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/15/2015] [Revised: 03/07/2016] [Accepted: 03/12/2016] [Indexed: 12/27/2022]
Abstract
OBJECTIVES The study sought to report safety and long-term clinical efficacy of intravascular brachytherapy (VBT) for recurrent drug-eluting stent in-stent restenosis (DES-ISR). BACKGROUND Recurrent DES-ISR remains a therapeutic challenge, and VBT has been used selectively in recurrent DES failure. METHODS Patients undergoing VBT for recurrent DES-ISR were enrolled from a percutaneous coronary intervention registry. Clinical, procedural, VBT, and outcome data were collected for DES-ISR treated with radiation. Follow-up was obtained by phone call and clinic visits. RESULTS A total of 186 patients (283 lesions) were included. Mean age was 65 ± 11 years, and 115 (61.8%) were men. Mean time to failure from last failed DES implantation was 450.65 ± 50 days. Majority (95%) had >2 episodes of target lesion revascularization (TLR). Commonest presentation of DES-ISR was unstable angina (68, 30%). All lesions were treated with balloon angioplasty followed by VBT using Beta-Cath system (Best Vascular Inc., Springfield, Virginia) with a dose of 23 to 25 Gy at 2 mm from source center. Radiation was delivered to site of ISR, without procedural adverse events, in 99% cases. Incidence of TLR was 3.3% at 6 months, 12.1% at 1 year, 19.1% at 2 years, and 20.7% at 3 years. No subacute thrombosis event was noted. One patient had late thrombosis during a 3-year follow-up. CONCLUSIONS VBT for recurrent DES-ISR is safe, with low recurrence rates at 12 months post-procedure, and can be safely used as an effective short-term strategy. Overtime, there is a gradual attrition in patency requiring repeat intervention.
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Affiliation(s)
- Smita I Negi
- Section of Interventional Cardiology, MedStar Washington Hospital Center, Washington, DC
| | - Rebecca Torguson
- Section of Interventional Cardiology, MedStar Washington Hospital Center, Washington, DC
| | - Jiaxiang Gai
- Section of Interventional Cardiology, MedStar Washington Hospital Center, Washington, DC
| | - Sarkis Kiramijyan
- Section of Interventional Cardiology, MedStar Washington Hospital Center, Washington, DC
| | - Edward Koifman
- Section of Interventional Cardiology, MedStar Washington Hospital Center, Washington, DC
| | - Rosanna Chan
- Section of Interventional Cardiology, MedStar Washington Hospital Center, Washington, DC
| | - Pamela Randolph
- Section of Interventional Cardiology, MedStar Washington Hospital Center, Washington, DC
| | - Augusto Pichard
- Section of Interventional Cardiology, MedStar Washington Hospital Center, Washington, DC
| | - Lowell F Satler
- Section of Interventional Cardiology, MedStar Washington Hospital Center, Washington, DC
| | - Ron Waksman
- Section of Interventional Cardiology, MedStar Washington Hospital Center, Washington, DC.
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Yabe T, Toda M, Nakanishi R, Saito D, Watanabe I, Okubo R, Amano H, Ikeda T. Same or Different Drug-Eluting Stent Re-Implantation for Drug-Eluting Stent Restenosis: An Assessment Including Second-Generation Drug-Eluting Stents. J Interv Cardiol 2016; 29:311-8. [PMID: 27245125 DOI: 10.1111/joic.12299] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
OBJECTIVES We examined the long-term outcomes of implanting a different type of drug-eluting stent (DES), including second-generation DES, for treatment of DES-in stent restenosis (ISR). BACKGROUND Treatment for DES-ISR has not been standardized. METHODS The subjects were 80 patients with 89 lesions underwent DES implantation for DES-ISR. The patients were divided into the group of patients receiving the same DES for DES-ISR (Homo-stent: 24 patients, 25 lesions) and a different DES for DES-ISR (Hetero-stent: 56 patients, 64 lesions). The primary endpoint was survival free of major adverse cardiovascular events (MACE), including cardiac death, myocardial infarction, and target vessel revascularization (TVR). The secondary endpoint was late loss at 8-12 months follow-up. In the subgroup of patients who were treated with second-generation DES for DES-ISR, we also assessed the survival free of MACE. RESULTS During a mean follow-up of 45.1 ± 21.2 months, 26 patients experienced MACE. There was no significant difference in the survival free of MACE (Log rank P = 0.17). In the sub-analysis of second generation DES, MACE was significantly higher in the Homo-stent group compared to the Hetero-stent group (Log rank P = 0.04). Late loss was significantly higher in the Homo-stent group than in the Hetero-stent group (0.86 ± 1.03 vs. 0.38 ± 0.74 mm, P = 0.03). This trend was prominent in the first-generation DES group. CONCLUSIONS Although there was no significant difference in MACE between the Hetero-stent and the Homo-stent groups including both first and second-generation DES, the sub-analysis demonstrated different DES implantation for DES-ISR significantly improved the MACE rate among patients treated with second-generation DES. (J Interven Cardiol 2016;29:311-318).
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Affiliation(s)
- Takayuki Yabe
- Department of Cardiovascular Medicine, Toho University Faculty of Medicine, Tokyo, Japan
| | - Mikihito Toda
- Department of Cardiovascular Medicine, Toho University Faculty of Medicine, Tokyo, Japan
| | - Rine Nakanishi
- Department of Cardiovascular Medicine, Toho University Faculty of Medicine, Tokyo, Japan
| | - Daiga Saito
- Department of Cardiovascular Medicine, Toho University Faculty of Medicine, Tokyo, Japan
| | - Ippei Watanabe
- Department of Cardiovascular Medicine, Toho University Faculty of Medicine, Tokyo, Japan
| | - Ryo Okubo
- Department of Cardiovascular Medicine, Toho University Faculty of Medicine, Tokyo, Japan
| | - Hideo Amano
- Department of Cardiovascular Medicine, Toho University Faculty of Medicine, Tokyo, Japan
| | - Takanori Ikeda
- Department of Cardiovascular Medicine, Toho University Faculty of Medicine, Tokyo, Japan
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Abstract
In-stent restenosis (ISR) is the narrowing of a stented coronary artery lesion. The mean time from percutaneous coronary intervention (PCI) to ISR was 12 months with drug-eluting stents (DES) and 6 months with bare metal stents (BMS). ISR typically presents as recurrent angina. The use of DES has significantly reduced the rate of ISR compared with BMS. Predictors of ISR include patient, lesion, and procedural characteristics. Intravascular ultrasound, optical coherence tomography, and fractional flow reserve are important tools for the anatomic and hemodynamic assessment of ISR. Treatment options for ISR include percutaneous coronary intervention with DES.
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Affiliation(s)
- Michael S Lee
- Cardiology Division, Department of Medicine, UCLA Medical Center, 100 Medical Plaza Suite 630, Los Angeles, CA 90095, USA.
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Goel SS, Dilip Gajulapalli R, Athappan G, Philip F, Gupta S, Murat Tuzcu E, Ellis SG, Mishkel G, Kapadia SR. Management of drug eluting stent in-stent restenosis: A systematic review and meta-analysis. Catheter Cardiovasc Interv 2015; 87:1080-91. [PMID: 26613637 DOI: 10.1002/ccd.26151] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/04/2015] [Revised: 07/14/2015] [Accepted: 07/21/2015] [Indexed: 12/28/2022]
Abstract
BACKGROUND The optimal management for coronary drug eluting stent in-stent restenosis (DES ISR) is unclear. We performed a meta-analysis of observational and randomized studies to compare the outcomes of management of DES ISR using DES, drug eluting balloon (DEB), or balloon angioplasty (BA). METHODS Eligible studies (25 single arm and 13 comparative, including 4 randomized studies with a total of 7,474 patients with DES ISR) were identified using MEDLINE search and proceedings of international meetings. Outcomes studied include major adverse cardiac events (MACE), target lesion revascularization (TLR), target vessel revascularization (TVR), myocardial infarction (MI), stent thrombosis (ST), and mortality. Follow-up ranged from 0.5 to 3.5 years (mean 1.4 years). RESULTS The rate of TLR was significantly lower in the DES (odds ratio [OR] 0.50, 95% confidence interval [CI] 0.36-0.69) and DEB (OR 0.31, 95% CI 0.18-0.55) groups compared to BA. Similarly, TVR rate was significantly lower in the DES (OR 0.55, 95% CI 0.39-0.77) and DEB (OR 0.32, 95% CI 0.18-0.58) groups compared to BA. All other outcomes were similar between the DES/BA and DEB/BA comparisons. TLR was significantly lower in the DES group compared to BA for vessels < or > 2.75 mm. CONCLUSION Treatment of coronary DES ISR with DES or DEB is associated with a reduction in the risk of TLR and TVR compared to BA alone. The relative risk reduction for TLR with DES is similar to DEB. DEBs have a potential role in the treatment of DES ISR by avoiding placement of another layer of stent. © 2015 Wiley Periodicals, Inc.
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Affiliation(s)
- Sachin S Goel
- Prairie Cardiovascular Consultants at St John's Hospital, Springfield, Illinois
| | | | | | - Femi Philip
- Division of Cardiovascular Medicine, University of California (Davis) Medical Center, Sacramento, California
| | - Supriya Gupta
- Department of Cardiovascular Medicine, Cleveland Clinic Foundation, Cleveland, Ohio
| | - E Murat Tuzcu
- Department of Cardiovascular Medicine, Cleveland Clinic Foundation, Cleveland, Ohio
| | - Stephen G Ellis
- Department of Cardiovascular Medicine, Cleveland Clinic Foundation, Cleveland, Ohio
| | - Gregory Mishkel
- Prairie Cardiovascular Consultants at St John's Hospital, Springfield, Illinois
| | - Samir R Kapadia
- Department of Cardiovascular Medicine, Cleveland Clinic Foundation, Cleveland, Ohio
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Ota H, Mahmoudi M, Kitabata H, Torguson R, Chen F, Satler LF, Suddath WO, Pichard AD, Waksman R. Safety and efficacy of limus-eluting stents and balloon angioplasty for sirolimus-eluting in-stent restenosis. CARDIOVASCULAR REVASCULARIZATION MEDICINE 2015; 16:84-9. [DOI: 10.1016/j.carrev.2015.01.004] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2015] [Accepted: 01/23/2015] [Indexed: 10/24/2022]
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Kubo S, Kadota K, Otsuru S, Hasegawa D, Habara S, Tada T, Tanaka H, Fuku Y, Katoh H, Goto T, Mitsudo K. Everolimus-eluting stent implantation versus repeat paclitaxel-coated balloon angioplasty for recurrent in-stent restenosis lesion caused by paclitaxel-coated balloon failure. EUROINTERVENTION 2015; 10:e1-8. [DOI: 10.4244/eijv10i9a180] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
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12
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Drug-eluting stents for drug-eluting stent restenosis: stick with the old or switch to a new one? Coron Artery Dis 2014; 25:633-5. [PMID: 25365642 DOI: 10.1097/mca.0000000000000171] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Paclitaxel-coated balloon for the treatment of drug-eluting stent restenosis: subanalysis results from the Valentines I trial. CARDIOVASCULAR REVASCULARIZATION MEDICINE 2014; 15:23-8. [PMID: 24444473 DOI: 10.1016/j.carrev.2013.08.011] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2013] [Accepted: 08/26/2013] [Indexed: 11/20/2022]
Abstract
OBJECTIVES To analyze the effect of paclitaxel-coated balloon (PCB) treatment on patients with drug-eluting stent (DES) restenosis. BACKGROUND In the Valentines I trial, treatment of coronary in-stent restenosis was effective and safe with the second-generation DIOR® PCB. METHODS Valentines I prospectively enrolled 250 patients with in-stent restenosis (ISR); 76 patients (30.4%) had restenosis of a previous paclitaxel or limus DES. Patients underwent balloon angioplasty followed by PCB treatment. Clinical outcomes of patients with paclitaxel-eluting DES restenosis (n=34; 41 lesions) and limus-eluting (sirolimus, everolimus and zotarolimus) DES restenosis (n=42; 43 lesions) treated with DIOR® PCB were compared. RESULTS Baseline characteristics were similar. There were more diffuse lesions >20mm treated in paclitaxel- compared to limus-eluting DES restenosis (50% vs. 26.8%, p=0.032). Number of PCB used per patient (1.08±0.31 overall), mean PCB diameter (2.99±0.42mm overall), mean PCB length (24.4±11.9mm overall), and bailout stenting (2.4% vs. 4.7%) were similar (p=NS). At mean follow-up of 231±43days, major adverse cardiac events was 0% vs. 23.8% in paclitaxel- vs. limus-eluting DES restenosis (p=0.002), driven mainly by less target vessel revascularization (0% vs. 21.4%, p=0.004). Target lesion revascularization was 0% vs. 16.7% for paclitaxel- vs. limus-eluting DES restenosis (p=0.015). CONCLUSION In Valentines I, PCB use was more effective in patients with paclitaxel DES restenosis compared to limus DES restenosis, achieving better mid-term clinical outcomes. This suggests the efficacy of localized paclitaxel delivery to overcome paclitaxel resistance but not limus resistance due to different mechanisms of DES failure.
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Switching types of drug-eluting stents does not prevent repeated in-stent restenosis in patients with coronary drug-eluting stent restenosis. Coron Artery Dis 2014; 25:638-44. [PMID: 25076360 PMCID: PMC4222797 DOI: 10.1097/mca.0000000000000159] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVES We treated patients experiencing drug-eluting stent (DES) restenosis with plain old balloon angioplasty (POBA), implantation of the same type of DES [homogeneous drug-eluting stent (HOMO-DES)], or implantation of a different type of DES [heterogeneous drug-eluting stent (HETERO-DES)], and compared the efficacy and safety of these procedures for the prevention of repeated in-stent restenosis (ISR). BACKGROUND In patients with de-novo coronary lesions, DES implantation is associated with a markedly reduced restenosis rate as compared with that associated with a bare metal stent and POBA. However, the optimal management strategy for patients with DES ISR remains unknown. PATIENTS AND METHODS We identified 191 consecutive DES ISR lesions from 183 patients who required clinically driven revascularization and divided them into three groups according to the treatment: 38 lesions were treated with POBA, 38 with HOMO-DES, and 115 with HETERO-DES. RESULTS The incidence of target lesion revascularization (TLR) was 42.1% (16/38), 15.8% (6/38), and 16.5% (19/115) in the POBA, HOMO-DES, and HETERO-DES groups (POBA vs. HOMO, HETERO-DES; P=0.002, respectively). Multivariate analysis indicated that diabetes [odds ratio (OR), 3.4], hemodialysis (OR, 7.74), nonfocal ISR patterns (OR, 3.35), previous myocardial infarction (OR, 3.26), and POBA (OR, 8.84) were independent predictors of TLR. CONCLUSION A strategy involving repeated DES implantation was superior to POBA for preventing recurrent restenosis. Treatment with a different type or generation of DES does not appear to reduce the incidence of TLR. Moreover, we identified certain useful factors for facilitating appropriate and early triage in the patients with repeated DES ISR.
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15
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Minha S, Pichard AD, Waksman R. In-stent restenosis of drug-eluting stents. Future Cardiol 2014; 9:721-31. [PMID: 24020673 DOI: 10.2217/fca.13.45] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
Abstract
Drug-eluting stents (DES) have emerged as an improved alternative to bare-metal stents by demonstrating reduced rates of restenosis and target lesion revascularization. This emergence has led to the unrestricted use of DES for various indications and lesions, and subsequently revealed DES in-stent restenosis as a novel interventional therapeutic dilemma. Recent insights regarding the patho-physiological processes and therapeutic alternatives have added to the accumulated knowledge regarding the appropriate approach to this phenomenon. This review aims to detail the mechanism and clinical presentation of, and therapeutic strategies for, the treatment of DES in in-stent restenosis.
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Affiliation(s)
- Sa'ar Minha
- Interventional Cardiology, MedStar Washington Hospital Center, Washington, DC, USA
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16
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Vyas A, Schweizer M, Malhotra A, Karrowni W. Meta-analysis of same versus different stent for drug-eluting stent restenosis. Am J Cardiol 2014; 113:601-6. [PMID: 24342760 DOI: 10.1016/j.amjcard.2013.10.041] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/14/2013] [Revised: 10/15/2013] [Accepted: 10/15/2013] [Indexed: 11/30/2022]
Abstract
Drug-eluting stent (DES) in-stent restenosis (ISR) can be treated by restenting using the same DES as previously placed (same stent strategy), versus switching to a stent that elutes a different drug (different stent strategy). To compare the efficacy of these strategies, a meta-analysis of controlled trials and observational studies evaluating patients with DES ISR was performed. The primary outcome was target lesion revascularization or target vessel revascularization, and secondary outcomes were major adverse cardiovascular events, death, and myocardial infarction. Pooled odds ratios (ORs) were calculated with the generic inverse variance method using a random-effects model. The chi-square test was used to evaluate heterogeneity. Ten studies (1,680 patients) were included. There was no significant heterogeneity among the studies for any end point. The different stent strategy was found to reduce the odds of target lesion revascularization or target vessel revascularization (OR 0.73, 95% confidence interval [CI] 0.55 to 0.96) and major adverse cardiovascular events (OR 0.72, 95% CI 0.54 to 0.96). There was no difference between the 2 strategies in rates of death (OR 1.03, 95% CI 0.49 to 2.16) or myocardial infarction (OR 0.59, 95% CI 0.24 to 1.41). In conclusion, this study demonstrates that treatment of DES ISR by restenting with a different DES than previously placed may lead to improved outcomes compared with the use of the same DES. Further large-scale trials are needed to confirm this effect.
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Affiliation(s)
- Ankur Vyas
- Division of Cardiovascular Medicine, University of Iowa Hospitals and Clinics, Iowa City, Iowa.
| | - Marin Schweizer
- Center for Comprehensive Access & Delivery Research and Evaluation, Iowa City Veterans Affairs Health Care System, Iowa City, Iowa; Department of Internal Medicine, University of Iowa Hospitals and Clinics, Iowa City, Iowa
| | - Ashish Malhotra
- Center for Comprehensive Access & Delivery Research and Evaluation, Iowa City Veterans Affairs Health Care System, Iowa City, Iowa; Department of Internal Medicine, University of Iowa Hospitals and Clinics, Iowa City, Iowa
| | - Wassef Karrowni
- Division of Cardiovascular Medicine, University of Iowa Hospitals and Clinics, Iowa City, Iowa
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Byrne RA, Cassese S, Windisch T, King LA, Joner M, Tada T, Mehilli J, Pache J, Kastrati A. Differential relative efficacy between drug-eluting stents in patients with bare metal and drug-eluting stent restenosis; evidence in support of drug resistance: insights from the ISAR-DESIRE and ISAR-DESIRE 2 trials. EUROINTERVENTION 2013; 9:797-802. [DOI: 10.4244/eijv9i7a132] [Citation(s) in RCA: 45] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
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18
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Ishikawa K, Aoyama Y, Kato K, Tanaka A, Hiramatsu M, Ajioka M, Kamiya H, Tanaka T, Hirayama H. Treatment of sirolimus-eluting stent restenosis: additional stent, balloon angioplasty, and coronary artery bypass graft. J Card Surg 2013; 28:97-101. [PMID: 23347085 DOI: 10.1111/jocs.12056] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
OBJECTIVE Sirolimus-eluting stent (SES) has shown a significant efficacy in reducing restenosis after percutaneous coronary interventions. However, an increase in total number of SES use along with targeting more complex lesions generated a large number of SES restenosis. This study aimed to investigate the clinical and angiographic outcomes of different revascularization strategies for SES restenosis. METHODS AND RESULTS A total of 176 lesions in 149 patients were included in the study. Fifteen patients underwent coronary artery bypass graft surgery (CABG group) and the remaining patients were treated with percutaneous coronary intervention (PCI). Stent reimplantation was performed in 88 patients (Stent group), whereas 46 patients received balloon therapy (Balloon group). Among 176 lesions, major cardiac adverse event (MACE) occurred in 41 lesions (23.3%) during a median follow-up of 310 days (interquartile range: 146-517 days). The Kaplan-Meier method with a log-rank test revealed no significant difference in MACE rates between the three groups (6%, 25%, 26%, p = 0.13; CABG group, Stent group, Balloon group, respectively). However, when the Balloon group and Stent group were combined together as a PCI group, PCI group had a significantly higher rate of MACE compared with the CABG group (p = 0.04). In addition, angiographic restenosis was significantly less prevalent in the CABG group when compared with the other two groups (8%, 57%, 46%, p = 0.006; CABG group, Stent group, Balloon group, respectively). CONCLUSIONS CABG surgery for patients with SES restenosis is associated with the better clinical outcomes as well as better angiographic outcomes when compared with that of PCI.
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Affiliation(s)
- Kiyotake Ishikawa
- Department of Cardiology, Nagoya Daini Red Cross Hospital, Nagoya, Japan.
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19
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Alfonso F, Pérez-Vizcayno MJ, Dutary J, Zueco J, Cequier A, García-Touchard A, Martí V, Lozano I, Angel J, Hernández JM, López-Mínguez JR, Melgares R, Moreno R, Seidelberger B, Fernández C, Hernandez R. Implantation of a drug-eluting stent with a different drug (switch strategy) in patients with drug-eluting stent restenosis. Results from a prospective multicenter study (RIBS III [Restenosis Intra-Stent: Balloon Angioplasty Versus Drug-Eluting Stent]). JACC Cardiovasc Interv 2012; 5:728-37. [PMID: 22814777 DOI: 10.1016/j.jcin.2012.03.017] [Citation(s) in RCA: 80] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/25/2012] [Revised: 03/07/2012] [Accepted: 03/16/2012] [Indexed: 12/13/2022]
Abstract
OBJECTIVES This study sought to assess the effectiveness of a strategy of using drug-eluting stents (DES) with a different drug (switch) in patients with DES in-stent restenosis (ISR). BACKGROUND Treatment of patients with DES ISR remains a challenge. METHODS The RIBS-III (Restenosis Intra-Stent: Balloon Angioplasty Versus Drug-Eluting Stent) study was a prospective, multicenter study that aimed to assess results of coronary interventions in patients with DES ISR. The use of a different DES was the recommended strategy. The main angiographic endpoint was minimal lumen diameter at 9-month follow-up. The main clinical outcome measure was a composite of cardiac death, myocardial infarction, and target lesion revascularization. RESULTS This study included 363 consecutive patients with DES ISR from 12 Spanish sites. The different-DES strategy was used in 274 patients (75%) and alternative therapeutic modalities (no switch) in 89 patients (25%). Baseline characteristics were similar in the 2 groups, although lesion length was longer in the switch group. At late angiographic follow-up (77% of eligible patients, median: 278 days) minimal lumen diameter was larger (1.86 ± 0.7 mm vs. 1.40 ± 0.8 mm, p = 0.003) and recurrent restenosis rate lower (22% vs. 40%, p = 0.008) in the different-DES group. At the last clinical follow-up (99% of patients, median: 771 days), the combined clinical endpoint occurred less frequently (23% vs. 35%, p = 0.039) in the different-DES group. After adjustment using propensity score analyses, restenosis rate (relative risk: 0.41, 95% confidence interval [CI]: 0.21 to 0.80, p = 0.01), minimal lumen diameter (difference: 0.41 mm, 95% CI: 0.19 to 0.62, p = 0.001), and the event-free survival (hazard ratio: 0.56, 95% CI: 0.33 to 0.96, p = 0.038) remained significantly improved in the switch group. CONCLUSIONS In patients with DES ISR, the implantation of a different DES provides superior late clinical and angiographic results than do alternative interventional modalities.
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Affiliation(s)
- Fernando Alfonso
- Clinico San Carlos University Hospital, Plaza de Cristo Rey, Madrid, Spain.
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20
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Freixa X, Almasood AS, Khan SQ, Mackie K, Osten M, Ing D, Overgaard CB, Horlick EM, Seidelin PH, Džavík V. Choice of stent and outcomes after treatment of drug-eluting stent restenosis in highly complex lesions. Catheter Cardiovasc Interv 2012; 81:E16-22. [DOI: 10.1002/ccd.24291] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/26/2011] [Accepted: 12/10/2011] [Indexed: 11/08/2022]
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Ko YG, Kim JS, Kim BK, Choi D, Hong MK, Jeon DW, Yang JY, Ahn YK, Jeong MH, Yu CW, Yun KH, Lim DS, Jang Y. Efficacy of drug-eluting stents for treating in-stent restenosis of drug-eluting stents (from the Korean DES ISR multicenter registry study [KISS]). Am J Cardiol 2012; 109:607-13. [PMID: 22172241 DOI: 10.1016/j.amjcard.2011.10.014] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/10/2011] [Revised: 10/21/2011] [Accepted: 10/21/2011] [Indexed: 11/15/2022]
Abstract
There is currently no established standard treatment for in-stent restenosis (ISR) after the implantation of a drug-eluting stent (DES). The aim of this study was to investigate the efficacy of DES versus balloon angioplasty (BA) for the treatment of DES ISR in a multicenter registry cohort. After matching propensity scores of 805 patients with DES ISR treated with either DES (n = 422) or BA (n = 383), 268 matched pairs were selected and analyzed for major adverse cardiac events, a composite of death, myocardial infarction, and target-vessel revascularization, as the primary end point. Baseline clinical and lesion characteristics of the matched pairs were similar. Survival free of major adverse cardiac events at 2 years was higher with DES compared to BA (88.9% vs 78.7%, p <0.001), mainly because of higher TVR-free survival (92.4% vs 81.0%, p <0.001). Among various baseline variables, BA (hazard ratio 2.546, 95% confidence interval 1.412 to 4.593, p = 0.002) was the most important independent risk factor for recurrent target vessel revascularization, followed by acute coronary syndromes as the clinical presentation of DES ISR, and previous implantation of a sirolimus-eluting stent. Survival free of death, myocardial infarction, or stent thrombosis did not differ between the 2 groups. Whereas there was no significant difference in survival free of target vessel revascularization between DES and BA for focal ISR lesions, DES was superior to BA in diffuse ISR lesions (94.3% vs 75.2% at 2 years, p <0.001). In conclusion, compared to BA, the implantation of DES was safe and more effective in the treatment of DES ISR.
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Affiliation(s)
- Young-Guk Ko
- Severance Cardiovascular Hospital, Yonsei University Health System, Seoul, Korea
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Rittger H, Brachmann J, Sinha AM, Waliszewski M, Ohlow M, Brugger A, Thiele H, Birkemeyer R, Kurowski V, Breithardt OA, Schmidt M, Zimmermann S, Lonke S, von Cranach M, Nguyen TV, Daniel WG, Wöhrle J. A randomized, multicenter, single-blinded trial comparing paclitaxel-coated balloon angioplasty with plain balloon angioplasty in drug-eluting stent restenosis: the PEPCAD-DES study. J Am Coll Cardiol 2012; 59:1377-82. [PMID: 22386286 DOI: 10.1016/j.jacc.2012.01.015] [Citation(s) in RCA: 267] [Impact Index Per Article: 22.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/26/2011] [Revised: 01/09/2012] [Accepted: 01/10/2012] [Indexed: 11/20/2022]
Abstract
OBJECTIVES This study sought to define the impact of paclitaxel-coated balloon angioplasty for treatment of drug-eluting stent restenosis compared with uncoated balloon angioplasty alone. BACKGROUND Drug-coated balloon angioplasty is associated with favorable results for treatment of bare-metal stent restenosis. METHODS In this prospective, single-blind, multicenter, randomized trial, the authors randomly assigned 110 patients with drug-eluting stent restenoses located in a native coronary artery to paclitaxel-coated balloon angioplasty or uncoated balloon angioplasty. Dual antiplatelet therapy was prescribed for 6 months. Angiographic follow-up was scheduled at 6 months. The primary endpoint was late lumen loss. The secondary clinical endpoint was a composite of cardiac death, myocardial infarction attributed to the target vessel, or target lesion revascularization. RESULTS There was no difference in patient baseline characteristics or procedural results. Angiographic follow-up rate was 91%. Treatment with paclitaxel-coated balloon was superior to balloon angioplasty alone with a late loss of 0.43 ± 0.61 mm versus 1.03 ± 0.77 mm (p < 0.001), respectively. Restenosis rate was significantly reduced from 58.1% to 17.2% (p < 0.001), and the composite clinical endpoint was significantly reduced from 50.0% to 16.7% (p < 0.001), respectively. CONCLUSIONS Paclitaxel-coated balloon angioplasty is superior to balloon angioplasty alone for treatment of drug-eluting stent restenosis. (PEPCAD DES-Treatment of DES-In-Stent Restenosis With SeQuent® Please Paclitaxel Eluting PTCA Catheter [PEPCAD-DES]; NCT00998439).
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Affiliation(s)
- Harald Rittger
- Medizinische Klinik 2, Universitätsklinikum Erlangen, Erlangen, Germany.
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Maluenda G, Ben-Dor I, Gaglia MA, Wakabayashi K, Mahmoudi M, Sardi G, Laynez-Carnicero A, Torguson R, Xue Z, Margulies AD, Suddath WO, Kent KM, Bernardo NL, Satler LF, Pichard AD, Waksman R. Clinical Outcomes and Treatment After Drug-Eluting Stent Failure. Circ Cardiovasc Interv 2012; 5:12-9. [DOI: 10.1161/circinterventions.111.963215] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
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 (
P
=0.41). 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 (
P
=0.57). 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.
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Affiliation(s)
- Gabriel Maluenda
- From Division of Cardiology, Washington Hospital Center, Washington, DC (G.M., I.B.-D., M.A.G., K.W., M.M., G.S., A.L.-C., R.T., Z.X., A.D.M., W.O.S., K.M.K., N.L.B., L.F.S., A.D.P., R.W.)
| | - Itsik Ben-Dor
- From Division of Cardiology, Washington Hospital Center, Washington, DC (G.M., I.B.-D., M.A.G., K.W., M.M., G.S., A.L.-C., R.T., Z.X., A.D.M., W.O.S., K.M.K., N.L.B., L.F.S., A.D.P., R.W.)
| | - Michael A. Gaglia
- From Division of Cardiology, Washington Hospital Center, Washington, DC (G.M., I.B.-D., M.A.G., K.W., M.M., G.S., A.L.-C., R.T., Z.X., A.D.M., W.O.S., K.M.K., N.L.B., L.F.S., A.D.P., R.W.)
| | - Kohei Wakabayashi
- From Division of Cardiology, Washington Hospital Center, Washington, DC (G.M., I.B.-D., M.A.G., K.W., M.M., G.S., A.L.-C., R.T., Z.X., A.D.M., W.O.S., K.M.K., N.L.B., L.F.S., A.D.P., R.W.)
| | - Michael Mahmoudi
- From Division of Cardiology, Washington Hospital Center, Washington, DC (G.M., I.B.-D., M.A.G., K.W., M.M., G.S., A.L.-C., R.T., Z.X., A.D.M., W.O.S., K.M.K., N.L.B., L.F.S., A.D.P., R.W.)
| | - Gabriel Sardi
- From Division of Cardiology, Washington Hospital Center, Washington, DC (G.M., I.B.-D., M.A.G., K.W., M.M., G.S., A.L.-C., R.T., Z.X., A.D.M., W.O.S., K.M.K., N.L.B., L.F.S., A.D.P., R.W.)
| | - Ana Laynez-Carnicero
- From Division of Cardiology, Washington Hospital Center, Washington, DC (G.M., I.B.-D., M.A.G., K.W., M.M., G.S., A.L.-C., R.T., Z.X., A.D.M., W.O.S., K.M.K., N.L.B., L.F.S., A.D.P., R.W.)
| | - Rebecca Torguson
- From Division of Cardiology, Washington Hospital Center, Washington, DC (G.M., I.B.-D., M.A.G., K.W., M.M., G.S., A.L.-C., R.T., Z.X., A.D.M., W.O.S., K.M.K., N.L.B., L.F.S., A.D.P., R.W.)
| | - Zhenyi Xue
- From Division of Cardiology, Washington Hospital Center, Washington, DC (G.M., I.B.-D., M.A.G., K.W., M.M., G.S., A.L.-C., R.T., Z.X., A.D.M., W.O.S., K.M.K., N.L.B., L.F.S., A.D.P., R.W.)
| | - Adrian D. Margulies
- From Division of Cardiology, Washington Hospital Center, Washington, DC (G.M., I.B.-D., M.A.G., K.W., M.M., G.S., A.L.-C., R.T., Z.X., A.D.M., W.O.S., K.M.K., N.L.B., L.F.S., A.D.P., R.W.)
| | - William O. Suddath
- From Division of Cardiology, Washington Hospital Center, Washington, DC (G.M., I.B.-D., M.A.G., K.W., M.M., G.S., A.L.-C., R.T., Z.X., A.D.M., W.O.S., K.M.K., N.L.B., L.F.S., A.D.P., R.W.)
| | - Kenneth M. Kent
- From Division of Cardiology, Washington Hospital Center, Washington, DC (G.M., I.B.-D., M.A.G., K.W., M.M., G.S., A.L.-C., R.T., Z.X., A.D.M., W.O.S., K.M.K., N.L.B., L.F.S., A.D.P., R.W.)
| | - Nelson L. Bernardo
- From Division of Cardiology, Washington Hospital Center, Washington, DC (G.M., I.B.-D., M.A.G., K.W., M.M., G.S., A.L.-C., R.T., Z.X., A.D.M., W.O.S., K.M.K., N.L.B., L.F.S., A.D.P., R.W.)
| | - Lowell F. Satler
- From Division of Cardiology, Washington Hospital Center, Washington, DC (G.M., I.B.-D., M.A.G., K.W., M.M., G.S., A.L.-C., R.T., Z.X., A.D.M., W.O.S., K.M.K., N.L.B., L.F.S., A.D.P., R.W.)
| | - Augusto D. Pichard
- From Division of Cardiology, Washington Hospital Center, Washington, DC (G.M., I.B.-D., M.A.G., K.W., M.M., G.S., A.L.-C., R.T., Z.X., A.D.M., W.O.S., K.M.K., N.L.B., L.F.S., A.D.P., R.W.)
| | - Ron Waksman
- From Division of Cardiology, Washington Hospital Center, Washington, DC (G.M., I.B.-D., M.A.G., K.W., M.M., G.S., A.L.-C., R.T., Z.X., A.D.M., W.O.S., K.M.K., N.L.B., L.F.S., A.D.P., R.W.)
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Scheller B, Levenson B, Joner M, Zahn R, Klauss V, Naber C, Schächinger V, Elsässer A. Medikamente freisetzende Koronarstents und mit Medikamenten beschichtete Ballonkatheter. DER KARDIOLOGE 2011. [DOI: 10.1007/s12181-011-0375-6] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
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Long-term outcomes after the percutaneous treatment of drug-eluting stent restenosis. JACC Cardiovasc Interv 2011; 4:155-64. [PMID: 21349453 DOI: 10.1016/j.jcin.2010.09.027] [Citation(s) in RCA: 61] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/04/2010] [Accepted: 09/03/2010] [Indexed: 11/20/2022]
Abstract
OBJECTIVES This study sought to evaluate the long-term angiographic and clinical outcomes after the treatment of drug-eluting stent in-stent restenosis (DES-ISR) based on the angiographic pattern of restenosis. BACKGROUND Long-term outcomes after percutaneous treatment of DES-ISR are unclear. METHODS This study performed a retrospective analysis of 481 consecutive de novo DES-ISR lesions (n = 392) treated percutaneously between August 2002 and July 2007. The lesions were divided based on the pattern of restenosis: focal (305; 63.4%), diffuse (120; 24.9%), and occlusive (56; 11.6%). RESULTS The majority (65%) of patients had angina or ischemia on presentation and 13% had an acute coronary syndrome. Angiographic follow-up after treatment of DES-ISR was available in 65.5% of lesions. A second angiographic restenosis occurred in 29.1% of the focal group, 45.8% (p = 0.007) of the diffuse, and 65.6% (p < 0.0001) of the occlusive. The pattern of DES-ISR predicted the pattern of recurrence: occlusive reoccluded in 66.7%; diffuse recurred as diffuse or occlusive in 57.9%; focal as focal in 67.2%. During a median follow-up of 2.97 years (interquartile range: 2.37 to 3.89), major adverse cardiac events occurred in 32.8% of patients with no significant differences among the focal, diffuse, and occlusive groups (30.9%, 38.7%, 31.1%; p = 0.38). Diffuse restenosis was associated with a significantly higher target lesion revascularization rate compared with focal (27.1% vs. 15.8%; p = 0.008). A disparity between restenosis (65.6%) and target lesion revascularization (18.5%) rates for occlusive DES-ISR suggests that as many recurrent restenoses were occlusive, they were not retreated. CONCLUSIONS DES-ISR identifies a high-risk cohort that is at an increased risk of events, in particular repeat revascularization, during long-term follow-up. The initial pattern of restenosis is the most important predictor of recurrent restenosis or the need for subsequent reintervention.
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Habara S, Mitsudo K, Kadota K, Goto T, Fujii S, Yamamoto H, Katoh H, Oka N, Fuku Y, Hosogi S, Hirono A, Maruo T, Tanaka H, Shigemoto Y, Hasegawa D, Tasaka H, Kusunose M, Otsuru S, Okamoto Y, Saito N, Tsujimoto Y, Eguchi H, Miyake K, Yoshino M. Effectiveness of paclitaxel-eluting balloon catheter in patients with sirolimus-eluting stent restenosis. JACC Cardiovasc Interv 2011; 4:149-54. [PMID: 21349452 DOI: 10.1016/j.jcin.2010.10.012] [Citation(s) in RCA: 191] [Impact Index Per Article: 14.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/10/2010] [Revised: 10/14/2010] [Accepted: 10/17/2010] [Indexed: 11/28/2022]
Abstract
OBJECTIVES The aim of this study was to investigate the efficacy of a paclitaxel-eluting balloon (PEB) for the treatment of sirolimus-eluting stent (SES) restenosis. BACKGROUND Because drug-eluting stents (DES) are being used in increasingly complicated settings, DES restenosis is no longer an uncommon phenomenon, and its optimal treatment is unknown. METHODS This study was a prospective single-blind randomized trial conducted in 50 patients with SES restenosis. Patients were randomly assigned to a PEB group (n = 25) or a conventional balloon angioplasty (BA) group (n = 25). The primary end point was late lumen loss at 6-month follow-up. Secondary end points included the rate of binary restenosis (in-segment analysis) and major adverse cardiac events (MACE) at 6-month follow-up. RESULTS At 6-month angiographic follow-up (follow-up rate: 94%), in-segment late lumen loss was lower in the PEB group than in the BA group (0.18 ± 0.45 mm vs. 0.72 ± 0.55 mm; p = 0.001). The incidence of recurrent restenosis (8.7% vs. 62.5%; p = 0.0001) and target lesion revascularization (4.3% vs. 41.7%; p = 0.003) was also lower in the PEB group than in the BA group. The cumulative MACE-free survival was significantly better in the PEB group than in the BA group (96% vs. 60%; p = 0.005). CONCLUSIONS In patients with SES restenosis, PEB provided much better clinical, angiographic outcomes than conventional BA.
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Affiliation(s)
- Seiji Habara
- Department of Cardiology, Kurashiki Central Hospital, Kurashiki, Japan.
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Aoki J, Caixeta A, Dangas GD, Mehran R. In-Stent Restenosis in the DES Era. Interv Cardiol 2011. [DOI: 10.1002/9781444319446.ch30] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
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Rathore S, Kinoshita Y, Terashima M, Katoh O, Tanaka N, Kimura M, Tsuchikane E, Nasu K, Ehara M, Asakura K, Asakura Y, Suzuki T. Sirolimus eluting stent restenosis: Impact of angiographic patterns and the treatment factors on angiographic outcomes in contemporary practice. Int J Cardiol 2011; 146:390-4. [DOI: 10.1016/j.ijcard.2009.07.010] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/10/2009] [Revised: 06/28/2009] [Accepted: 07/19/2009] [Indexed: 11/17/2022]
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Dangas GD, Claessen BE, Caixeta A, Sanidas EA, Mintz GS, Mehran R. In-stent restenosis in the drug-eluting stent era. J Am Coll Cardiol 2011; 56:1897-907. [PMID: 21109112 DOI: 10.1016/j.jacc.2010.07.028] [Citation(s) in RCA: 553] [Impact Index Per Article: 42.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/28/2010] [Revised: 06/25/2010] [Accepted: 07/27/2010] [Indexed: 12/20/2022]
Abstract
The introduction of the drug-eluting stent (DES) proved to be an important step forward in reducing rates of restenosis and target lesion revascularization after percutaneous coronary intervention. However, the rapid implementation of DES in standard practice and expansion of the indications for percutaneous coronary intervention to high-risk patients and complex lesions also introduced a new problem: DES in-stent restenosis (ISR), which occurs in 3% to 20% of patients, depending on patient and lesion characteristics and DES type. The clinical presentation of DES ISR is usually recurrent angina, but some patients present with acute coronary syndrome. Mechanisms of DES ISR can be biological, mechanical, and technical, and its pattern is predominantly focal. Intravascular imaging can assist in defining the mechanism and selecting treatment modalities. Based upon the current available evidence, an algorithm for the treatment approaches to DES restenosis is proposed.
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Affiliation(s)
- George D Dangas
- Cardiovascular Institute, Mount Sinai Medical Center, New York, New York 10029, USA.
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Ge H, Zhang Q, Zhou W, He Q, Han ZH, He B. Efficacy and safety of drug-eluting stent implantation for the treatment of in-stent restenosis occurring within bare-metal stent and drug-eluting stent. J Zhejiang Univ Sci B 2010; 11:553-60. [PMID: 20669344 DOI: 10.1631/jzus.b1001002] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
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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Affiliation(s)
- Heng Ge
- Department of Cardiology, Shanghai Renji Hospital, Shanghai Jiao Tong University, China
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Maluenda G, Ben-Dor I, Wakabayashi K, Satler LF, Waksman R, Pichard AD. Intravascular ultrasound guidance for percutaneous coronary intervention in the current practice era. Interv Cardiol 2010. [DOI: 10.2217/ica.10.61] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
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Treatment of drug-eluting stent restenosis the new pilgrimage: quo vadis? J Am Coll Cardiol 2010; 55:2717-20. [PMID: 20538164 DOI: 10.1016/j.jacc.2010.03.026] [Citation(s) in RCA: 33] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/09/2010] [Revised: 03/23/2010] [Accepted: 03/30/2010] [Indexed: 11/24/2022]
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Tiroch KA, Byrne RA, Kastrati A. Pharmacological prevention and management of restenosis. Expert Opin Pharmacother 2010; 11:1855-72. [DOI: 10.1517/14656566.2010.485610] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
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Abstract
The introduction of coronary stents marked a major turning point in the practice of interventional cardiology. Whereas the efficacy of balloon angioplasty was challenged both by immediate mechanical complications and by a high incidence of restenosis, coronary stents offered cardiologists a means by which to not only augment immediate procedural success, but also to reduce the incidence of restenosis following coronary intervention. However, despite technological advances and an improved understanding of the restenotic process, the overall rate of in-stent restenosis following bare metal stent implantation remains high. Although the introduction of drug-eluting stents has further reduced the incidence of restenosis, the "real-world" application of drug-eluting stents in increasingly complex lesion and patient subsets has given way to the even greater clinical challenge of managing drug-eluting stent restenosis. Although the standard treatment of bare metal stent restenosis typically involves placement of a drug-eluting stent, the optimal therapeutic approach to drug-eluting stent restenosis remains less defined. The issue of in-stent restenosis (especially following implantation of a drug-eluting stent) remains a clinical challenge, and investigation into therapeutic options remains ongoing. As technology evolves, such investigation will likely incorporate novel approaches including drug-coated balloons novel stent designs.
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Affiliation(s)
- Michael S Kim
- Division of Cardiology, University of Washington School of Medicine, Seattle, WA 98195-6116, USA.
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Mehilli J, Byrne RA, Tiroch K, Pinieck S, Schulz S, Kufner S, Massberg S, Laugwitz KL, Schömig A, Kastrati A. Randomized trial of paclitaxel- versus sirolimus-eluting stents for treatment of coronary restenosis in sirolimus-eluting stents: the ISAR-DESIRE 2 (Intracoronary Stenting and Angiographic Results: Drug Eluting Stents for In-Stent Restenosis 2) study. J Am Coll Cardiol 2010; 55:2710-6. [PMID: 20226618 DOI: 10.1016/j.jacc.2010.02.009] [Citation(s) in RCA: 157] [Impact Index Per Article: 11.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/21/2009] [Revised: 02/08/2010] [Accepted: 02/09/2010] [Indexed: 11/19/2022]
Abstract
OBJECTIVES For patients with sirolimus-eluting stent (SES) restenosis requiring reintervention, we compared a strategy of repeat SES (Cypher, Cordis, Miami Lakes, Florida) implantation with paclitaxel-eluting stent (PES) (Taxus, Boston Scientific, Natick, Massachusetts) implantation. BACKGROUND Despite their high anti-restenotic efficacy, the widespread utilization of SES therapy has led to a significant absolute number of patients presenting with SES treatment failure. The optimal treatment strategy for such patients remains unclear. METHODS The ISAR-DESIRE 2 (Intracoronary Stenting and Angiographic Results: Drug Eluting Stents for In-Stent Restenosis 2) study was a randomized, open-label, active-controlled trial conducted among 450 patients with clinically significant in-SES restenosis at 2 centers in Munich, Germany. After pre-treatment with 600 mg clopidogrel, all patients were randomly assigned to either SES or PES implantation. The primary end point was late lumen loss, based on in-stent analysis, at 6- to 8-month follow-up angiography. Secondary end points were binary angiographic restenosis (diameter stenosis >50%) at 6- to 8-month follow-up, target lesion revascularization, the composite of death or myocardial infarction, and definite stent thrombosis at 12 months. RESULTS Regarding anti-restenotic efficacy, there were no differences between SES and PES in late loss (0.40 +/- 0.65 mm vs. 0.38 +/- 0.59 mm; p = 0.85), binary restenosis (19.6% vs. 20.6%; p = 0.69), or target lesion revascularization (16.6% vs. 14.6%; p = 0.52). In terms of safety outcomes, the rates of death/myocardial infarction (6.1% vs. 5.8%; p = 0.86) and stent thrombosis (0.4% vs. 0.4%; p > 0.99) were also similar. CONCLUSIONS In cases of SES restenosis, treatment with either repeat SES or switch to PES was associated with a comparable degree of efficacy and safety. Drug resistance at an individual patient level may play a contributory role to the somewhat higher than expected late loss observed with the SES in the current study. (Intracoronary Stenting and Angiographic Results: Drug-Eluting Stents for In-Stent Restenosis 2 [ISAR-DESIRE 2]; NCT00598715).
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Affiliation(s)
- Julinda Mehilli
- Deutsches Herzzentrum, Technische Universität, Munich, Germany
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37
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Rathore S, Kinoshita Y, Terashima M, Katoh O, Matsuo H, Tanaka N, Kimura M, Tsuchikane E, Nasu K, Ehara M, Asakura K, Asakura Y, Suzuki T. A comparison of clinical presentations, angiographic patterns and outcomes of in-stent restenosis between bare metal stents and drug eluting stents. EUROINTERVENTION 2010; 5:841-846. [DOI: 10.4244/eijv5i7a141] [Citation(s) in RCA: 53] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 08/30/2023]
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Tagliareni F, La Manna A, Saia F, Marzocchi A, Tamburino C. Long-term clinical follow-up of drug-eluting stent restenosis treatment: retrospective analysis from two high volume catheterisation laboratories. EUROINTERVENTION 2010; 5:703-8. [DOI: 10.4244/eijv5i6a116] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
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CHATANI KENICHI, MURAMATSU TOSHIYA, TSUKAHARA REIKO, ITO YOSHIAKI, ISHIMORI HIROSHI, HIRANO KEISUKE, NAKANO MASATSUGU, YAMAWAKI MASAHIRO, ARAKI MOTOHARU, SAKURAI MASAYUKI, IUCHI KAZUYUKI, NOZAWA TAKASHI, INOUE HIROSHI. Predictive Factors of Re-restenosis after Repeated Sirolimus-Eluting Stent Implantation for SES Restenosis and Clinical Outcomes after Percutaneous Coronary Intervention for SES Restenosis. J Interv Cardiol 2009; 22:354-61. [DOI: 10.1111/j.1540-8183.2009.00482.x] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
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40
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Aminian A, Kabir T, Eeckhout E. Treatment of drug-eluting stent restenosis: An emerging challenge. Catheter Cardiovasc Interv 2009; 74:108-16. [DOI: 10.1002/ccd.21938] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
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POP ANDREI, GRINES CINDYL. Choice of DES: A US Clinician's Perspective. J Interv Cardiol 2009. [DOI: 10.1111/j.1540-8183.2009.00453.x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
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Steinberg DH, Gaglia MA, Pinto Slottow TL, Roy P, Bonello L, De Labriolle A, Lemesle G, Torguson R, Kineshige K, Xue Z, Suddath WO, Kent KM, Satler LF, Pichard AD, Lindsay J, Waksman R. Outcome differences with the use of drug-eluting stents for the treatment of in-stent restenosis of bare-metal stents versus drug-eluting stents. Am J Cardiol 2009; 103:491-5. [PMID: 19195508 DOI: 10.1016/j.amjcard.2008.09.107] [Citation(s) in RCA: 79] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/30/2008] [Revised: 09/29/2008] [Accepted: 09/29/2008] [Indexed: 11/30/2022]
Abstract
Drug-eluting stent (DES) implantation is the standard treatment for patients with bare-metal stent (BMS) in-stent restenosis (ISR) and is associated with low rates of target-vessel revascularization. Outcomes in patients with DES ISR treated using repeated DES placement are less certain. A total of 119 patients who presented with BMS ISR and 119 patients with DES ISR matched for baseline characteristics were evaluated. Both groups of patients were treated using DESs and compared with regard to major adverse cardiac events, including death, myocardial infarction, and target-vessel revascularization, at 1 year. Baseline characteristics were similar between groups. Compared with patients with BMS ISR, those with DES ISR had similar 1-year rates of death (5.1% BMS ISR vs 3.5% DES ISR; p = 0.75) and myocardial infarction (2.6% BMS ISR vs 3.5% DES ISR; p = 0.72) when treated using DESs. However, at 1 year, patients with DES ISR experienced significantly higher rates of target-vessel revascularization (10.3% BMS ISR vs 22.2% DES ISR; p = 0.01), with a trend toward increased overall major adverse cardiac events, including death, myocardial infarction, and target-vessel revascularization (16.0% BMS ISR vs 25.2% DES ISR; p = 0.08). Stent thrombosis occurred with similar frequency in both groups (2.5% BMS ISR vs 0.8% DES ISR; p = 0.62). In conclusion, DES ISR continues to be a therapeutic challenge because patients with DES ISR treated using DESs experience higher rates of recurrence compared with patients with BMS ISR treated using DESs. The optimal treatment of patients with DES restenosis remains to be defined.
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Affiliation(s)
- Daniel H Steinberg
- Department of Internal Medicine, Washington Hospital Center, Washington, DC, USA
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Kitahara H, Kobayashi Y, Takebayashi H, Nakamura Y, Kuroda N, Miyazaki A, Haruta S, Komuro I. Angiographic Patterns of Restenosis After Sirolimus-Eluting Stent Implantation. Circ J 2009; 73:508-11. [DOI: 10.1253/circj.cj-08-0720] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Affiliation(s)
- Hideki Kitahara
- Department of Cardiovascular Science and Medicine, Chiba University Graduate School of Medicine
| | - Yoshio Kobayashi
- Department of Cardiovascular Science and Medicine, Chiba University Graduate School of Medicine
| | | | | | - Nakabumi Kuroda
- Department of Cardiovascular Science and Medicine, Chiba University Graduate School of Medicine
| | | | - Seiichi Haruta
- Division of Cardiology, Fukuyama Cardiovascular Hospital
| | - Issei Komuro
- Department of Cardiovascular Science and Medicine, Chiba University Graduate School of Medicine
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Kitahara H, Kobayashi Y, Takebayashi H, Fujimoto Y, Nakamura Y, Kuroda N, Himi T, Miyazaki A, Haruta S, Komuro I. Re-Restenosis and Target Lesion Revascularization After Treatment of Sirolimus-Eluting Stent Restenosis Retrospective Analysis From 4 Japanese Hospitals. Circ J 2009; 73:867-71. [DOI: 10.1253/circj.cj-08-0851] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Affiliation(s)
- Hideki Kitahara
- Department of Cardiovascular Science and Medicine, Chiba University Graduate School of Medicine
| | - Yoshio Kobayashi
- Department of Cardiovascular Science and Medicine, Chiba University Graduate School of Medicine
| | | | | | | | - Nakabumi Kuroda
- Department of Cardiovascular Science and Medicine, Chiba University Graduate School of Medicine
| | | | | | - Seiichi Haruta
- Division of Cardiology, Fukuyama Cardiovascular Hospital
| | - Issei Komuro
- Department of Cardiovascular Science and Medicine, Chiba University Graduate School of Medicine
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BONELLO LAURENT, KANESHIGE KIMBERLY, DE LABRIOLLE AXEL, ROY PROBAL, LEMESLE GILLES, TORGUSON REBECCA, SATLER LOWELLF, PICHARD AUGUSTOD, LINDSAY JOSEPH, WAKSMAN RON. Vascular Brachytherapy for Patients with Drug-Eluting Stent Restenosis. J Interv Cardiol 2008; 21:528-34. [DOI: 10.1111/j.1540-8183.2008.00414.x] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
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Colombo A, Latib A. Tratamiento de la reestenosis de un stent liberador de fármacos con otro stent liberador de fármacos: ¡no fallar en el segundo intento! Rev Esp Cardiol 2008. [DOI: 10.1157/13127841] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
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Belardi J. Treatment of drug-eluting stent restenosis: a sandwich may not be the best combo. Catheter Cardiovasc Interv 2008; 71:599. [PMID: 18360848 DOI: 10.1002/ccd.21568] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
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48
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Whan Lee C, Kim SH, Suh J, Park DW, Lee SH, Kim YH, Hong MK, Kim JJ, Park SW, Park SJ. Long-term clinical outcomes after sirolimus-eluting stent implantation for treatment of restenosis within bare-metal versus drug-eluting stents. Catheter Cardiovasc Interv 2008; 71:594-8. [DOI: 10.1002/ccd.21399] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
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