Registry data evaluating the effectiveness of drug-eluting stents for the treatment of symptomatic in-stent restenosis.
BACKGROUND
In this new-era of drug-eluting stents (DES) the impact of symptomatic in-stent restenosis (ISR) is diminishing. However, world wide bare-metal stents remain widely used and therefore, it is imperative to establish a simple and effective form of treatment. The objective of this registry database was to evaluate the 'real-world' effectiveness of DES for the treatment of symptomatic bare-metal stent ISR.


METHODS
All patients presenting with symptomatic ISR were evaluated between February 2003 and February 2005. Patients had 9-month angiographic follow-up with primary endpoint evaluation of binary restenosis (>50%). Secondary endpoints included in-segment late loss, target lesion revascularization (TLR) and the difference in late loss between sirolimus (n=23) and paciltaxel (n=36) eluting stents.


RESULTS
Fifty eight patients with fifty nine ISR lesions were evaluated, 36% of patients had diabetes mellitus. All procedures were performed safely with no adverse peri-procedural events documented. At 9-month follow-up the median in-segment late loss was 0.24 mm (IQR 0.1, 0.53), with a binary restenosis rate of 17%. At long-term follow-up greater than 1 year, the incidence of TLR was 10%. No difference in the angiographic parameter of in-segment late loss was seen between the sirolimus and paclitaxel-eluting stents.


CONCLUSIONS
In this cohort of patients with long-term angiographic and clinical follow-up, DES is an effective and safe treatment for symptomatic bare-metal stent ISR.
Worthley
Matthew I
MI
Foothills Interventional Cardiology Service, Department of Cardiovascular Sciences and the Libin Cardiovascular Institute, University of Calgary, Calgary, Alberta, Canada. miworthl@ucalgary.ca <miworthl@ucalgary.ca>
Anderson
Todd J
TJ
Traboulsi
Mouhieddin
M
Charbonneau
Francois
F
Curtis
Michael J
MJ
Hansen
James L
JL
Knudtson
Merril L
ML
Spence
Frank P
FP
Goodhart
David M
DM
D000972:Antineoplastic Agents, Phytogenic / Q000494:pharmacology; D019917:Blood Vessel Prosthesis Implantation / Q000295:instrumentation*; D020099:Coated Materials, Biocompatible; D017023:Coronary Angiography; D023903:Coronary Restenosis / Q000000981:diagnostic imaging / Q000601:surgery*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007166:Immunosuppressive Agents / Q000494:pharmacology; D008297:Male; D008875:Middle Aged; D017239:Paclitaxel / Q000494:pharmacology*; D011475:Prosthesis Failure; D012086:Reoperation; D012189:Retrospective Studies; D020123:Sirolimus / Q000494:pharmacology*; D015607:Stents; D013997:Time Factors; D016896:Treatment Outcome
D000972:Antineoplastic Agents, Phytogenic; D020099:Coated Materials, Biocompatible; D007166:Immunosuppressive Agents; D017239:Paclitaxel; D020123:Sirolimus