title: Stenting the stent: initial results and long-term clinical and angiographic outcome of coronary stenting for patients with in-stent restenosis.
abstract: Stent restenosis constitutes a therapeutic challenge affecting an increasing number of patients. Conventional angioplasty and debulking techniques are currently used in these patients. However, the potential role of a second stent implantation in this setting (stenting the stent) remains unknown. Therefore, 65 consecutive patients (12 women, aged 62 +/- 11 years) undergoing stent implantation (42 elective and 23 unplanned) for the treatment of in-stent restenosis (diffuse [> 10 mm] in 39 [60%]) were studied. Angiographic success was obtained in all patients. Three patients developed hospital complications: 1 died from refractory heart failure and 2 suffered non-Q-wave myocardial infarctions. During follow-up (mean 17 +/- 11 months) 1 patient died (noncardiac cause) and only 9 (14%) required target vessel revascularization. Kaplan-Meier event-free survival (freedom from death, myocardial infarction, and target vessel revascularization) at 1 year was 84%. Using Cox analysis, patients with unstable symptoms, a short time to stent restenosis, nonelective stenting, and B2-C lesions tended to have poorer prognosis. After adjustment, nonelective stenting was associated (adjusted RR 2.9, 95% confidence interval [CI] 0.82 to 10.3, p = 0.09) with an adverse clinical outcome. On quantitative angiography (core lab) restenosis was found in 13 of 43 patients (30%) (75% of those eligible). Logistic regression analysis identify restenosis length (adjusted RR 1.43, 95% CI 1.04 to 2.14, p = 0.04), and time to restenosis (adjusted RR 0.67, 95% CI 0.47 to 0.94, p = 0.01) as the only independent predictors of recurrent restenosis. Thus, repeat coronary stenting is a safe and efficacious strategy for the treatment of patients with in-stent restenosis. Both elective and nonelective stenting provide excellent initial results. The long-term clinical and angiographic outcome of these patients is also favorable.
authors.affiliation: Interventional Cardiology Units, San Carlos University Hospital, Madrid, Spain.
authors.forename: F
authors.initials: F
authors.lastname: Alfonso
authors.forename: A
authors.initials: A
authors.lastname: Cequier
authors.forename: J
authors.initials: J
authors.lastname: Zueco
authors.forename: C
authors.initials: C
authors.lastname: Morís
authors.forename: C P
authors.initials: CP
authors.lastname: Suárez
authors.forename: T
authors.initials: T
authors.lastname: Colman
authors.forename: E
authors.initials: E
authors.lastname: Esplugas
authors.forename: M J
authors.initials: MJ
authors.lastname: Pérez-Vizcayno
authors.forename: C
authors.initials: C
authors.lastname: Fernández
authors.forename: C
authors.initials: C
authors.lastname: Macaya
mesh_terms: D017023:Coronary Angiography; D018572:Disease-Free Survival; D005260:Female; D005500:Follow-Up Studies; D006083:Graft Occlusion, Vascular / Q000401:mortality* / Q000601:surgery*; D006801:Humans; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D009204:Myocardial Revascularization; D016016:Proportional Hazards Models; D012086:Reoperation; D013030:Spain / Q000453:epidemiology; D015607:Stents