Repeated drug-eluting stent implantation for drug-eluting stent restenosis: the same or a different stent.
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.
Cosgrave
John
J
EMO Centro Cuore Columbus, Milan, Italy.
Melzi
Gloria
G
Corbett
Simon
S
Biondi-Zoccai
Giuseppe G L
GG
Babic
Rade
R
Airoldi
Flavio
F
Chieffo
Alaide
A
Sangiorgi
Giuseppe M
GM
Montorfano
Matteo
M
Michev
Iassen
I
Carlino
Mauro
M
Colombo
Antonio
A
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
D007166:Immunosuppressive Agents; D017239:Paclitaxel; D020123:Sirolimus