Use of drug-eluting stents for the treatment of in-stent restenosis in routine clinical practice.
BACKGROUND
Although target lesion revascularization (TLR) has been dramatically decreased by using drug-eluting stents (DESs) in de-novo lesions, their efficacy for in-stent restenosis (ISR) has not yet been well established.


METHODS
We retrospectively analysed patients treated for ISR with DESs from three referral hospitals.


RESULTS
Eighty-seven consecutive patients, from June 2002 to April 2004, were included, with a mean age of 64+/-11 years; 83% were men, 32% had diabetes, 47% had had a previous myocardial infarction and 16% had low left ventricular ejection fraction. Angiographic characteristics were as follows: mean vessel diameter, 3.05+/-0.4 mm; lesion length, 17.8+/-7.7 mm; diameter stenosis, 84.0+/-10.7%; and complex lesion, 81%. The restenosis was focal in 45%, diffuse/proliferative in 51.3% and total occlusion in 3.7% of the cases. Sirolimus- and paclitaxel-eluting stents were used in 42 and 58% of the patients, respectively. Stent diameter was 3.1+/-0.3 mm and the length was 26.1+/-5.8 mm. Angiographic success was achieved in all patients, with one patient experiencing a post-procedural non-Q-wave myocardial infarction. At 6-month clinical follow-up, two patients had died from non-cardiac deaths, five had experienced a new TLR (5.7%, four percutaneous and one coronary artery bypass graft) and eight (9.2%) had had major adverse cardiac events. A stress test was performed in 60% of the population; target vessel ischemia was observed in one patient (3.3%).


CONCLUSIONS
In this non-select cohort of patients, the use of DESs is a safe and effective strategy for ISR lesions.
Department of Cardiology, Instituto Cardiovascular de Buenos Aires, Argentina. jabelardi@ciudad.com.ar
Jorge A
JA
Belardi
Fernando
F
Cura
Mariano
M
Albertal
Lucio
L
Padilla
German
G
Solioz
Pablo Perez
PP
Balino
Julio A
JA
Pascua
Carlos
C
Fava
Daniel
D
Berrocal
Oscar
O
Mendiz
Liliana
L
Grinfeld
D000368:Aged; D019917:Blood Vessel Prosthesis Implantation / Q000379:methods; D020099:Coated Materials, Biocompatible / Q000627:therapeutic use*; D017023:Coronary Angiography; D023903:Coronary Restenosis / Q000000981:diagnostic imaging / Q000628:therapy*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007166:Immunosuppressive Agents / Q000627:therapeutic use; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000628:therapy; D017239:Paclitaxel / Q000627:therapeutic use; D010818:Practice Patterns, Physicians'; D012189:Retrospective Studies; D020123:Sirolimus / Q000627:therapeutic use; D015607:Stents; D016019:Survival Analysis; D016896:Treatment Outcome; D018487:Ventricular Dysfunction, Left / Q000628:therapy
D020099:Coated Materials, Biocompatible; D007166:Immunosuppressive Agents; D017239:Paclitaxel; D020123:Sirolimus