Procedural and long-term results of sirolimus-eluting stent in patients at high risk for restenosis.
OBJECTIVE
In-stent restenosis still affects 10-50% of long-term outcome after percutaneous coronary intervention (PCI). Large clinical trials have shown that sirolimus-eluting stents (SES) have reduced restenosis rate to 0-9% in lesions at low-moderate risk. The aim of this study was to evaluate long-term clinical and angiographic outcome of SES in a real world population, at very high risk of restenosis.


METHODS
Ninety lesions at high risk of restenosis (lesion length >20 mm, target vessel diameter <2.5 mm, in-stent diffuse restenosis, total occlusions and complex lesions on bypass grafts and bifurcations) were treated in 75 patients. A follow-up was scheduled at 6 months.


RESULTS
Restenosis rate was 16.6% with a focal pattern of presentation in most cases. Subacute in-stent thrombosis occurred in 2.2%. Resteno-sis occurred mainly in small vessels, diabetic patients and in vessels previously treated with brachytherapy.


CONCLUSIONS
The treatment of lesions at high risk of restenosis with SES is safe with a low restenosis rate at follow-up. An aggressive and prolonged antiplatelet regimen is mandatory because of high subacute in-stent thrombosis rates.
Presbitero
P
P
Invasive Cardiology Unit, Humanitas Clinical Institute, Rozzano, Milan, Italy. patrizia.presbitero@humanitas.it
Zavalloni
D
D
Scatturin
M
M
Marisco
F
F
Pagnotta
P
P
Boccuzzi
G
G
D023903:Coronary Restenosis / Q000453:epidemiology / Q000517:prevention & control*; D016503:Drug Delivery Systems; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007166:Immunosuppressive Agents / Q000008:administration & dosage*; D008297:Male; D008875:Middle Aged; D012307:Risk Factors; D020123:Sirolimus / Q000008:administration & dosage*; D015607:Stents; D013997:Time Factors
D007166:Immunosuppressive Agents; D020123:Sirolimus