title: Repeated drug-eluting stent implantation for drug-eluting stent restenosis: the same or a different stent.
abstract: BACKGROUND
  Currently, little data are available on the management of drug-eluting stent (DES) restenosis. Drug resistance may play a role in its etiology.
  
  
  METHODS
  We identified all cases of either sirolimus-eluting or paclitaxel-eluting stent restenosis treated with repeated DES implantation. The lesions were divided into those receiving the same DES as the one that restenosed and those treated with the alternative DES. The end points analyzed were target lesion revascularization (TLR) and angiographic restenosis.
  
  
  RESULTS
  We included 201 lesions (174 patients); the same DES was implanted in 107 lesions and a different DES in 94 lesions. Angiographic follow-up of the retreatment was available in 69.7% of the lesions. Angiographic restenosis occurred in 26.4% (19) of cases treated with the same DES and 25.8% (17) of those treated with a different DES (P = 1.0). Target lesion revascularization occurred in 15.9% (17) and 16% (15) of lesions, respectively (P = 1.0). A multivariate analysis confirmed the lack of association between the treatment selected and TLR (OR 0.7, 95% CIs [0.29-1.67]; P = .42). A nonfocal pattern of restenosis remained associated with TLR and restenosis (OR 2.99, 95% CIs [1.24-7.24]; P = .015 and OR 3.6, 95% CIs [1.5-8.8]; P = .004, respectively).
  
  
  CONCLUSIONS
  Repeated DES implantation for DES restenosis is feasible and safe. The TLR rate is acceptable, with no differences between implantation of the same or a different DES. The pattern of restenosis treated is an important predictor of outcomes.
authors.affiliation: EMO Centro Cuore Columbus, Milan, Italy.
authors.forename: John
authors.initials: J
authors.lastname: Cosgrave
authors.forename: Gloria
authors.initials: G
authors.lastname: Melzi
authors.forename: Simon
authors.initials: S
authors.lastname: Corbett
authors.forename: Giuseppe G L
authors.initials: GG
authors.lastname: Biondi-Zoccai
authors.forename: Rade
authors.initials: R
authors.lastname: Babic
authors.forename: Flavio
authors.initials: F
authors.lastname: Airoldi
authors.forename: Alaide
authors.initials: A
authors.lastname: Chieffo
authors.forename: Giuseppe M
authors.initials: GM
authors.lastname: Sangiorgi
authors.forename: Matteo
authors.initials: M
authors.lastname: Montorfano
authors.forename: Iassen
authors.initials: I
authors.lastname: Michev
authors.forename: Mauro
authors.initials: M
authors.lastname: Carlino
authors.forename: Antonio
authors.initials: A
authors.lastname: Colombo
mesh_terms: D000368:Aged; D017023:Coronary Angiography; D023903:Coronary Restenosis / Q000188:drug therapy*; D016503:Drug Delivery Systems; D005260:Female; D006801:Humans; D007166:Immunosuppressive Agents / Q000008:administration & dosage*; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D017239:Paclitaxel / Q000008:administration & dosage*; D011474:Prosthesis Design; D019233:Retreatment; D020123:Sirolimus / Q000008:administration & dosage*; D015607:Stents
chemical_list: D007166:Immunosuppressive Agents; D017239:Paclitaxel; D020123:Sirolimus