title: In-stent restenosis: long-term outcome and predictors of subsequent target lesion revascularization after repeat balloon angioplasty.
abstract: OBJECTIVE
  We sought to evaluate the long-term clinical outcome of patients undergoing successful balloon angioplasty for in-stent restenosis, and to determine correlates of the need for subsequent target lesion revascularization (TLR).
  
  
  BACKGROUND
  In-stent restenosis can be safely treated by repeat percutaneous intervention. Reported subsequent TLR rates have varied from 20% to 80% and seem related to the type of restenotic lesion.
  
  
  METHODS
  The study population comprised 234 patients with follow-up data who were successfully treated with repeat balloon angioplasty for in-stent restenosis in 257 lesions between May 1995 and January 1998 at our institution.
  
  
  RESULTS
  Clinical follow-up was available at 459 (286 to 693) days after the repeat procedure. Event-free survival was 78.5% and 74.6% at 12 and 24 months, respectively. Recurrent events occurred in 58 patients (24.8%), including 6 deaths (2.6%), 4 myocardial infarction (1.7%) and repeat target vessel revascularization in 50 patients (21.4%). Independent predictors of repeat TLR were time to in-stent restenosis <90 days (Hazard ratio 4.67, p < 0.001), minimal luminal diameter after repeat procedure (Hazard ratio 0.38, p = 0.034) and the angiographic pattern of in-stent restenosis (Hazard ratio 1.65, p = 0.036).
  
  
  CONCLUSIONS
  Balloon angioplasty is an effective means of treating in-stent restenosis. The long-term results are acceptable particularly for focal restenotic lesions. Further restenosis is more common in patients with early initial recurrence, more proliferative lesions and a poorer angiographic result from repeat angioplasty.
authors.affiliation: Unité de Cardiologie Interventionelle, Clinique Pasteur, Toulouse, France. marco@interv-cardio-toul.com
authors.forename: I
authors.initials: I
authors.lastname: Bossi
authors.forename: C
authors.initials: C
authors.lastname: Klersy
authors.forename: A J
authors.initials: AJ
authors.lastname: Black
authors.forename: R
authors.initials: R
authors.lastname: Cortina
authors.forename: R
authors.initials: R
authors.lastname: Choussat
authors.forename: B
authors.initials: B
authors.lastname: Cassagneau
authors.forename: C
authors.initials: C
authors.lastname: Jordan
authors.forename: J C
authors.initials: JC
authors.lastname: Laborde
authors.forename: J P
authors.initials: JP
authors.lastname: Laurent
authors.forename: M
authors.initials: M
authors.lastname: Bernies
authors.forename: J
authors.initials: J
authors.lastname: Fajadet
authors.forename: J
authors.initials: J
authors.lastname: Marco
mesh_terms: D000368:Aged; D015906:Angioplasty, Balloon, Coronary; D003327:Coronary Disease / Q000000981:diagnostic imaging / Q000401:mortality / Q000628:therapy*; D004868:Equipment Failure; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D011859:Radiography; D012008:Recurrence; D019233:Retreatment; D015607:Stents; D015996:Survival Rate