title: What is the best contemporary treatment for in-stent restenosis?
abstract: In-stent restenosis (ISR) remains a challenging problem in percutaneous coronary intervention and the optimal treatment strategy remains unclear. The aim of this study was to compare the 18 month clinical outcomes in patients receiving sirolimus-eluting stents (SES) with vascular brachytherapy (VBT) for the treatment of ISR. Twenty-five consecutive patients treated with VBT were compared with 29 patients who had SES deployment for ISR. Major adverse cardiac events (MACE) were defined as a combination of death from cardiac causes, nonfatal myocardial infarction, or repeat TVR. At 18 month follow-up, the MACE rate was significantly lower in the SES compared with the VBT group (14% vs 40%, P=.03). One patient in the VBT group developed late stent thrombosis (at 10 months) and died; there was no stent thrombosis in the SES group. This observational study, taken with other recent reports, offers further credence to the use of SES for ISR. The results of randomized comparisons with VBT are awaited with interest.
authors.affiliation: Department of Cardiology, Austin Hospital, Studley Road, PO Box 5555, Heidelberg, Victoria 3084, Australia.
authors.forename: Peter
authors.initials: P
authors.lastname: Barlis
authors.forename: Mark C G
authors.initials: MC
authors.lastname: Horrigan
authors.forename: Robert K
authors.initials: RK
authors.lastname: Chan
authors.forename: Andrew E
authors.initials: AE
authors.lastname: Ajani
authors.forename: George
authors.initials: G
authors.lastname: Proimos
authors.forename: Wendy
authors.initials: W
authors.lastname: Schumer
authors.forename: William J
authors.initials: WJ
authors.lastname: van Gaal
authors.forename: Michael
authors.initials: M
authors.lastname: Rowe
authors.forename: David
authors.initials: D
authors.lastname: Eccleston
authors.forename: Bryan B P
authors.initials: BB
authors.lastname: Yan
authors.forename: Yu
authors.initials: Y
authors.lastname: Mun Cheong
authors.forename: Les E
authors.initials: LE
authors.lastname: Oliver
authors.forename: David J
authors.initials: DJ
authors.lastname: Clark
mesh_terms: D000368:Aged; D019917:Blood Vessel Prosthesis Implantation / Q000295:instrumentation*; D001918:Brachytherapy / Q000379:methods*; D020099:Coated Materials, Biocompatible; D017023:Coronary Angiography; D023903:Coronary Restenosis / Q000000981:diagnostic imaging / Q000628:therapy*; D003657:Decision Making; D019160:Endosonography; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007166:Immunosuppressive Agents / Q000627:therapeutic use; D008297:Male; D012189:Retrospective Studies; D020123:Sirolimus / Q000627:therapeutic use; D015607:Stents; D016896:Treatment Outcome
chemical_list: D020099:Coated Materials, Biocompatible; D007166:Immunosuppressive Agents; D020123:Sirolimus