Post-sirolimus-eluting stent restenosis treated with repeat percutaneous intervention: late angiographic and clinical outcomes.
BACKGROUND
We evaluated the clinical and angiographic outcomes of patients presenting with restenosis after sirolimus-eluting stent (SES) implantation treated with repeated percutaneous intervention.


RESULTS
A total of 24 consecutive patients have undergone repeated percutaneous intervention to treat post-SES restenosis (27 lesions). The restenosis was located within the stent in 93% of lesions. From the 27 lesions, 1 (4%) was re-treated with a bare stent, 3 (11%) were treated with balloon dilatation, and the remaining 23 lesions (85%) were treated with repeated drug-eluting stent implantation (SES in 12 lesions [44%], paclitaxel-eluting stents in 11 lesions [41%]). The event-free survival rate was 70.8% after a median follow-up of 279 days from the post-SES treatment. The overall recurrent restenosis rate was 42.9%. The risk of recurrent restenosis was increased for patients with hypercholesterolemia, previous angioplasty, failed brachytherapy, post-SES restenosis needing early (<6 months) treatment, and post-SES restenosis treated with balloon dilatation. The recurrent restenosis rate of originally de novo lesions re-treated with drug-eluting stents was 18.2%.


CONCLUSIONS
Even though de novo lesions treated with SES at baseline and re-treated with drug-eluting stents had reasonably better outcomes than other lesion types and strategies, our study shows that the treatment of post-SES restenosis is currently suboptimal and warrants further investigation.
Lemos
Pedro A
PA
Erasmus Medical Center, Thoraxcenter, Rotterdam, The Netherlands.
van Mieghem
Carlos A G
CA
Arampatzis
Chourmouzios A
CA
Hoye
Angela
A
Ong
Andrew T L
AT
McFadden
Eugene
E
Sianos
Georgios
G
van der Giessen
Willem J
WJ
de Feyter
Pim J
PJ
van Domburg
Ron T
RT
Serruys
Patrick W
PW
D000368:Aged; D015906:Angioplasty, Balloon, Coronary; D001918:Brachytherapy; D015331:Cohort Studies; D003131:Combined Modality Therapy; D023903:Coronary Restenosis / Q000000981:diagnostic imaging / Q000453:epidemiology / Q000628:therapy*; D023921:Coronary Stenosis / Q000188:drug therapy / Q000532:radiotherapy / Q000628:therapy; D018572:Disease-Free Survival; D004343:Drug Implants; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D006937:Hypercholesterolemia / Q000150:complications; D015994:Incidence; D008297:Male; D008875:Middle Aged; D017239:Paclitaxel / Q000008:administration & dosage / Q000627:therapeutic use; D011859:Radiography; D012008:Recurrence; D020123:Sirolimus / Q000008:administration & dosage / Q000627:therapeutic use*; D015607:Stents; D016896:Treatment Outcome
D004343:Drug Implants; D017239:Paclitaxel; D020123:Sirolimus