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Comparison between balloon angioplasty and additional coronary stent implantation for the treatment of drug-eluting stent restenosis: 18-month clinical outcomes

Sardella, Gennaro; Colantonio, Riccardo; De Luca, Leonardo; Conti, Giulia; Di Roma, Angelo; Mancone, Massimo; Canali, Emanuele; Benedetti, Giulia; Fedele, Francesco

Journal of Cardiovascular Medicine: June 2009 - Volume 10 - Issue 6 - p 469–473
doi: 10.2459/JCM.0b013e3283297c23
Original articles
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Objective To evaluate the long-term outcomes after different modalities of treatment of drug-eluting stent (DES) in-stent restenosis (ISR) in a ‘real world’ setting.

Methods Actually, few and conflicting data are available about the management of in-stent restenosis (ISR) after DES implantation. In our ‘real world’ registry 1082 consecutive patients who received a DES implantation were included. At 9-month angiographic follow-up, 93 patients presented a DES ISR that was treated with ‘homo-DES’ (HMD) (N = 27), ‘hetero-DES’ (HTD) (N = 19) and conventional balloon angioplasty (POBA) (N = 47). We evaluated the clinical outcomes in terms of major adverse cardiac event (MACE) (death, myocardial infarction and target vessel revascularization) at 18 months.

Results There was no difference for clinical and angiographic characteristics between the three groups, except for the presence of silent ischaemia as clinical presentation (7.7 HMD vs. 2.2% POBA; P = 0.0001). No late stent thrombosis was found. At 18-month clinical follow-up patients treated with HMD, HTD and POBA presented a rate of MACE of 10.2, 0 and 8.7%, respectively (P = NS). Kaplan–Meier survival probability showed that HTD and POBA treatment tended to have more favourable outcomes at 18 months than the HMD treatment.

Conclusion In our registry, POBA seems to be as effective as other DES implantations in cases of DES ISR, especially in cases of focal type (Mehran classification IA, IC), in terms of long-term outcomes.

Department of Cardiovascular Sciences, Policlinico Umberto I, ‘Sapienza’ University of Rome, Rome, Italy

Received 6 September, 2008

Revised 28 November, 2008

Accepted 20 January, 2009

Correspondence to Professor Gennaro Sardella, MD, FESC, FACC, Department of Cardiovascular Sciences, Policlinico Umberto I, ‘Sapienza’ University of Rome, Rome, Italy Tel: +39 06 49979035; fax: +39 06 49979047; e-mail: rino.sardella@uniroma1.it

© 2009 Italian Federation of Cardiology. All rights reserved.