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

In Brief 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.