Sirolimus-eluting and paclitaxel-eluting stents significantly reduced in-lesion restenosis rates (13% and 20%, respectively) compared to balloon angioplasty (61%, P=0.042) for in-stent restenosis.
Observational (n=77)
Do sirolimus-eluting or paclitaxel-eluting stents reduce MACE and angiographic restenosis compared to balloon angioplasty in patients with in-stent restenosis?
Both sirolimus-eluting and nonpolymer paclitaxel-eluting stents significantly reduce angiographic restenosis and clinical MACE compared to balloon angioplasty for the treatment of in-stent restenosis.
Absolute Event Rate: 13% vs 61%
p-value: p=0.042
This study evaluated the acute and follow-up effectiveness of sirolimus-eluting stents (SESs) and nonpolymer-based paclitaxel-eluting stents (PESs) in comparison will balloon angioplasty for treatment of complex in-stent restenosis (ISR) lesions. Drug-eluting stents have been demonstrated to be highly effective for treatment of de novo lesions. The use of drug-eluting stents for treatment of complex ISR is less well defined. Eighty one lesions with in-stent restenosis (lesion length < 30 mm in a native coronary artery) were treated with either PTCA alone (n = 26 lesions in 25 patients), PES (n = 27 lesions in 24 patients; Achieve, Cook; 3,1 mug paclitaxel/mm(2) nonpolymer-based coating), SES (n = 28 lesions in 28 patients; Cypher, Cordis; 140 mug sirolimus/cm(2) metal surface area). Nine-month MACE rates were 32%, 8%, and 14% (all due to repeated revascularization procedures, except one death in the SES group) in the PTCA, PES, and SES group, respectively. Postintervention minimal lumen diameter in stent was significantly greater in the SES and the PES group in comparison with the PTCA group (2.37 +/- 0.26, 2.54 +/- 0.42, 1.78 +/- 0.23 mm; P < 0.001). At 6-month angiographic follow-up, late loss in stent was 0.77 +/- 0.45, 0.43 +/- 0.53, and 0.29 +/- 0.52 mm for the PTCA, PES, and SES group, respectively (P = 0.005). In-lesion restenosis rate was 61% for the PTCA group, 20% for the PES group, and 13% for the SES group (P = 0.042). The implantation of SES as well as nonpolymer PES proved to be effective for treatment of ISR. The combination of improved acute gain and reduced late loss results in a significantly improved angiographic follow-up result in comparison with PTCA.
Iofina et al. (Thu,) conducted a observational in in-stent restenosis (n=77). Sirolimus-eluting stents (SES) and paclitaxel-eluting stents (PES) vs. Balloon angioplasty (PTCA) was evaluated on In-lesion restenosis rate (p=0.042). Sirolimus-eluting and paclitaxel-eluting stents significantly reduced in-lesion restenosis rates (13% and 20%, respectively) compared to balloon angioplasty (61%, P=0.042) for in-stent restenosis.