Key result
Treating DES ISR with EES yields a ~26% recurrent restenosis rate at 6-8 months.
Why the study?
Randomized data support drug-coated balloons and drug-eluting stents for ISR treatment, but additional real-world angiographic follow-up data are needed.
Does everolimus-eluting stent implantation improve angiographic outcomes in patients with drug-eluting stent in-stent restenosis?
Cohort (n=426)
Does everolimus-eluting stent implantation improve angiographic outcomes in patients with drug-eluting stent in-stent restenosis?
In real-world practice, everolimus-eluting stents for drug-eluting stent in-stent restenosis show a recurrent binary restenosis rate of 25.7% at 6-8 months, which is comparable to RCTs but less favorable than for de novo lesions.
Recurrent restenosis remains frequent after everolimus-eluting stents for DES-ISR in real-world cohorts; leaves open optimal strategy pending randomized trials.
OBJECTIVES: The present study aims to analyze the angiographic anti-restenotic performance of durable polymer everolimus-eluting stents (EES) for the treatment of in-stent restenosis (ISR) in daily practice. BACKGROUND: Randomized data is available supporting the use of drug-coated balloons and drug-eluting stents for the treatment of ISR; however, additional real-world data including angiographic follow-up is needed. METHODS: Patients who underwent EES-implantation for the treatment of drug-eluting stent ISR and attended for a 6-8 months angiographic surveillance were analyzed. Off-line assessment of the angiograms was conducted at a central quantitative coronary angiographic core laboratory. RESULTS: A total of 426 patients with ISR were treated with EES and had undergone angiographic follow-up. The mean age was 66.8 ± 9.9 years and 27.5% suffered from diabetes. A total of 459 lesions were treated. The diameter stenosis decreased from 64.3 ± 19.1% (preprocedural) to 12.0 ± 6.4% (postprocedural). At 6-8 months angiographic follow-up, the in-segment diameter stenosis was 38.3 ± 21.7% and the in-stent late luminal loss was 0.54 ± 0.74 mm in the treated area analysis. The rate of recurrent binary restenosis was 25.7%. CONCLUSIONS: In the setting of ISR, the angiographic anti-restenotic efficacy of stenting with EES is comparable to that observed in randomized clinical trials and less favorable than its performance in patients undergoing stenting for de novo disease.
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Wiebe et al. (2020) conducted a cohort in coronary in-stent restenosis (n=426). Everolimus-eluting stents was evaluated on recurrent binary restenosis. Treatment of drug-eluting stent in-stent restenosis with everolimus-eluting stents in daily practice resulted in a 25.7% rate of recurrent binary restenosis at 6-8 months.
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