title: Sirolimus-eluting stents for the prevention of restenosis in a worst-case scenario of diffuse and recurrent in-stent restenosis.
abstract: For recurrent in-stent restenosis (ISR), surgical revascularization or brachytherapy is still the principal therapeutic options. The present investigation explores the efficacy of a sirolimus-eluting stent to prevent restenosis in these lesions with a high risk of recurrence. In 22 consecutive patients with a recurrent and diffuse ISR, a sirolimus-eluting stent was implanted to cover the restenotic lesion. All patients were followed clinically for at least 1 year and underwent a repeat angiography after 7 months. A quantitative coronary angiographic analysis was done. The target vessel failure was 14% in the sirolimus-eluting stent group, with an angiographic late loss of only 0.39 +/- 0.54. No subacute stent thrombosis was observed, and the 1-year event-free survival was 86%. The three cases with restenosis were all focal and could be successfully treated by additional drug-eluting stent implantation. This study showed the efficacy of a sirolimus-eluting stent for the prevention of restenosis in a worst-case scenario of recurrent and diffuse ISR. The observed restenosis rate is lower than that reported after brachytherapy and suggests that sirolimus-eluting stents are a promising treatment option for ISR.
authors.affiliation: Clinic for Internal Medicine III, Friedrich Schiller University Jena, Jena, Germany. gerald.wener@med.uni-jena.de
authors.forename: Gerald S
authors.initials: GS
authors.lastname: Werner
authors.forename: Ulf
authors.initials: U
authors.lastname: Emig
authors.forename: Andreas
authors.initials: A
authors.lastname: Krack
authors.forename: Gero
authors.initials: G
authors.lastname: Schwarz
authors.forename: Hans R
authors.initials: HR
authors.lastname: Figulla
mesh_terms: D000368:Aged; D015906:Angioplasty, Balloon, Coronary; D001918:Brachytherapy; D017023:Coronary Angiography; D023903:Coronary Restenosis / Q000000981:diagnostic imaging / Q000517:prevention & control*; D023921:Coronary Stenosis / Q000628:therapy; D003925:Diabetic Angiopathies / Q000628:therapy; D005260:Female; D006801:Humans; D007166:Immunosuppressive Agents / Q000008:administration & dosage*; D008297:Male; D008875:Middle Aged; D012008:Recurrence; D020123:Sirolimus / Q000008:administration & dosage*; D015607:Stents
chemical_list: D007166:Immunosuppressive Agents; D020123:Sirolimus