title: Treatment of in-stent restenosis with sirolimus-eluting-stents -- a six month clinical and angiographic follow-up.
abstract: Treatment of in-stent restenosis (ISR) remains a therapeutic challenge since many pharmacological and mechanical approaches have shown disappointing results except for brachytherapy. Drug-eluting stents (DES) have been reported to effectively reduce ISR in de novo lesions. We studied 55 consecutive patients with ISR in native coronary arteries and 7 with ISR in saphenous vein grafts (SVG) with elective indication for percutaneous coronary intervention (PCI), who underwent successful implantation with DES. No in-hospital postprocedural major adverse cardiac events were observed. All but one patient (n=61) underwent an angiographic follow-up at 183+/-30 days. Grade of stenosis was assessed by quantitative coronary angiography (QCA) at index procedure and at control angiography. Restenosis (>50%) occurred in 5 patients (8.2%). Target vessel revascularization was performed in an additional 4 patients. Minimal intimal hyperplasia was observed in all segments covered by DES (late loss 0.08+/-0.37 mm, loss index 0.11+/-0.47). One patient suffered from subacute stent thrombosis due to discontinuation of clopidogrel medication. At six month follow-up two patients had died. Death was not related to a restenosis in the treated segment. Conclusion Our experiences with DES treatment of ISR lesions show good angiographic and clinical results at index procedure and at the 6 month follow-up with low sub acute thrombosis rate as compared with existing treatment modalities. Restenosis rate seems to be at least as low as reported for brachytherapy.
authors.affiliation: Department of Cardiology, Kerckhoff-Klinik, Benekestr. 2-8, 61231 Bad Nauheim, Germany. m.rau@kerckhoff-klinik.de
authors.forename: M
authors.initials: M
authors.lastname: Rau
authors.forename: C
authors.initials: C
authors.lastname: Maikowski
authors.forename: M
authors.initials: M
authors.lastname: Weber
authors.forename: E
authors.initials: E
authors.lastname: Keil
authors.forename: A
authors.initials: A
authors.lastname: Elsässer
authors.forename: H
authors.initials: H
authors.lastname: Möllmann
authors.forename: C
authors.initials: C
authors.lastname: Hamm
mesh_terms: D001807:Blood Vessel Prosthesis / Q000009:adverse effects*; D023903:Coronary Restenosis / Q000000981:diagnostic imaging / Q000188:drug therapy* / Q000209:etiology*; D004343:Drug Implants / Q000008:administration & dosage; D004867:Equipment Design; D019544:Equipment Failure Analysis; D005260:Female; D005500:Follow-Up Studies; D006083:Graft Occlusion, Vascular / Q000000981:diagnostic imaging / Q000188:drug therapy* / Q000209:etiology*; D006801:Humans; D007166:Immunosuppressive Agents / Q000008:administration & dosage; D008297:Male; D008875:Middle Aged; D011859:Radiography; D020123:Sirolimus / Q000008:administration & dosage*; D015607:Stents / Q000009:adverse effects*; D016896:Treatment Outcome
chemical_list: D004343:Drug Implants; D007166:Immunosuppressive Agents; D020123:Sirolimus