What is the best contemporary treatment for in-stent restenosis?
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.
Barlis
Peter
P
Department of Cardiology, Austin Hospital, Studley Road, PO Box 5555, Heidelberg, Victoria 3084, Australia.
Horrigan
Mark C G
MC
Chan
Robert K
RK
Ajani
Andrew E
AE
Proimos
George
G
Schumer
Wendy
W
van Gaal
William J
WJ
Rowe
Michael
M
Eccleston
David
D
Yan
Bryan B P
BB
Mun Cheong
Yu
Y
Oliver
Les E
LE
Clark
David J
DJ
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
D020099:Coated Materials, Biocompatible; D007166:Immunosuppressive Agents; D020123:Sirolimus