Effectiveness of Endovascular Treatment of in-Stent Restenosis After Successful Chronic Total Coronary Occlusion Recanalization

Aim. To assess the effectiveness of endovascular treatment of in-stent restenosis after successful chronic total coronary occlusion (CTO) recanalization. Methods. 117 patients who underwent successful CTO recanalization in the period from 2009 to 2012 were included in the study. All patients were referred to the elective examination including coronary angiography, intravascular ultrasound and optical coherence tomography within 6.1±0.9 months after the successful recanalization. If in-stent restenosis after CTO recanalization was confirmed and further endovascular treatment was performed, patients underwent repeat endovascular examination after 6.6±0.8 months. Сoronary artery lumen was evaluated at the sites of the performed intervention. Results. 18.8% of patients had in-stent restenosis, of them 95.5% underwent percutaneous coronary intervention. 76.2% of patients underwent high-pressure balloon predilatation, 4.8% of patients received paclitaxel-eluting balloons, 14.2% of patients – drug-eluting stents (DES), and 4.8% of patients - bare-metal stents. A significant increase of minimum lumen diameter after the percutaneous coronary intervention (from 0.8±0.5 mm to 2.2±0.3 mm, p<0.01) and a decrease of coronary artery lumen stenosis (from 67.9±18.3% to 19.7±8.8%, p<0.01) had been determined. There were no cases of death, acute myocardial infarction, acute strokes and target lesion thrombosis 6.6±0.8 months after the in-stent restenosis treatment. 52.8% of cases had repeat restenosis, including 56.3% of those who underwent high-pressure balloon predilatation and 33.3% of patients after DES implantation. The minimum lumen diameter decreased from 2.2±0.3 mm to 1.6±0.5 mm (p<0.01), and the degree of lumen stenosis increased from 19.7±8.8 mm2 to 41.5±17.3 mm2 (p<0.01). Conclusion. In-stent restenosis treatment after the successful CTO recanalization by the endovascular methods was effective in 47.2% of cases. DES and drug coated balloons can potentially reduce the rate of repeat restenosis.