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Use of drug-eluting stents for the treatment of in-stent restenosis in routine clinical practice

Belardi, Jorge A.a; Cura, Fernandoa; Albertal, Marianoa; Padilla, Lucioa; Solioz, Germana; Balino, Pablo Perez; Pascua, Julio A.b; Fava, Carlosc; Berrocal, Danielb; Mendiz, Oscarc; Grinfeld, Lilianab

Therapy and Prevention
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Background Although target lesion revascularization (TLR) has been dramatically decreased by using drug-eluting stents (DESs) in de-novo lesions, their efficacy for in-stent restenosis (ISR) has not yet been well established.

Methods We retrospectively analysed patients treated for ISR with DESs from three referral hospitals.

Results Eighty-seven consecutive patients, from June 2002 to April 2004, were included, with a mean age of 64±11 years; 83% were men, 32% had diabetes, 47% had had a previous myocardial infarction and 16% had low left ventricular ejection fraction. Angiographic characteristics were as follows: mean vessel diameter, 3.05±0.4 mm; lesion length, 17.8±7.7 mm; diameter stenosis, 84.0±10.7%; and complex lesion, 81%. The restenosis was focal in 45%, diffuse/proliferative in 51.3% and total occlusion in 3.7% of the cases. Sirolimus- and paclitaxel-eluting stents were used in 42 and 58% of the patients, respectively. Stent diameter was 3.1±0.3 mm and the length was 26.1±5.8 mm. Angiographic success was achieved in all patients, with one patient experiencing a post-procedural non-Q-wave myocardial infarction. At 6-month clinical follow-up, two patients had died from non-cardiac deaths, five had experienced a new TLR (5.7%, four percutaneous and one coronary artery bypass graft) and eight (9.2%) had had major adverse cardiac events. A stress test was performed in 60% of the population; target vessel ischemia was observed in one patient (3.3%).

Conclusion In this non-select cohort of patients, the use of DESs is a safe and effective strategy for ISR lesions.

A total of 87 consecutive patients with in-stent restenosis (ISR) underwent drug-eluting stent (DES) implantation as part of a multicenter registry. The restenosis was: focal 45%, diffuse/proliferative 51.3% and total occlusion in 3.7%. Sirolimus and paclitaxel-eluting stent were used in 42 and 58% of the cases, respectively. The stent diameter was 3.1±0.3mm and length 26.1±5.8mm. Angiographic success was achieved in all patients, with 1 patients experiencing a post-procedural non-Q wave myocardial infarction. At six-month clinical follow-up, 2 patients died of non-cardiac deaths, 5 underwent repeat revascularization (5.7%, 4 percutaneous and 1 surgical), and 8 (9.2%) had major adverse cardiac events. A stress test was performed in 60% of the population; ischemia in the target vessel area was observed in 1 patient (3.3%), however, coronary angiogram only showed atheroschlerotic progression in another vessel. Conclusion: In this non-select cohort of patients, DES was a safe and effective strategy for ISR lesions.

aDepartment of Cardiology, Instituto Cardiovascular de Buenos Aires

bDepartment of Cardiology, Hospital Italiano

cDepartment of Cardiology, Fundación Favaloro, Buenos Aires, Argentina

Correspondence and requests for reprints to Jorge A. Belardi, Department of Cardiology, Instituto Cardiovascular de Buenos Aires, Buenos Aires, Argentina (1428)

Tel: +54 11 4788 1199; fax: +54 11 4787 7534;

e-mail: jabelardi@ciudad.com.ar

Received 30 March 2005 Accepted 14 April 2005

© 2005 Lippincott Williams & Wilkins, Inc.