title: Contemporary treatment of in-stent restenosis and the incidence of recurrent in-stent restenosis in the era of drug-eluting stents.
abstract: BACKGROUND
  Optimal treatment of in-stent restenosis (ISR) remains uncertain in the era of drug-eluting stents (DES). This study aims to determine contemporary treatment of ISR and to assess recurrent ISR rates in the era of DES.
  
  
  METHODS
  We examined 60 patients presenting for treatment of ISR (one lesion per patient) who were enrolled in the Melbourne Interventional Group Registry (4% of total population of 1423 patients) between April 2004 and January 2005. Twelve-month follow-up is complete for all patients.
  
  
  RESULTS
  The majority of ISR treated occurred in bare metal stents [BMS (n=52, 87%)] and had a focal (<10 mm) pattern of ISR (53%). In-stent restenosis of DES occurred in eight (13%) patients. The majority of ISR were treated with additional stenting with a preference for DES over BMS in almost all cases. At 12 months, one patient died of non-cardiac cause and four patients (7%) presented with recurrent ISR. The incidence of recurrent ISR in DES was 5% (n=3). No late thrombosis was reported despite only 50% of patients having >or=12 months of clopidogrel therapy.
  
  
  CONCLUSIONS
  Our study suggests drug-eluting stents are safe, effective and the preferred therapy for in-stent restenosis. The incidence of recurrent drug-eluting stent restenosis at 12 months is low.
authors.affiliation: Department of Cardiology, Royal Melbourne Hospital, Melbourne, Australia. andrew.ajani@mh.org.au
authors.forename: Andrew E
authors.initials: AE
authors.lastname: Ajani
authors.forename: Bryan P
authors.initials: BP
authors.lastname: Yan
authors.forename: David J
authors.initials: DJ
authors.lastname: Clark
authors.forename: David
authors.initials: D
authors.lastname: Eccleston
authors.forename: Anthony
authors.initials: A
authors.lastname: Walton
authors.forename: Robert
authors.initials: R
authors.lastname: Lew
authors.forename: Adam
authors.initials: A
authors.lastname: Meehan
authors.forename: Angela
authors.initials: A
authors.lastname: Brennan
authors.forename: Chris
authors.initials: C
authors.lastname: Reid
authors.forename: Stephen J
authors.initials: SJ
authors.lastname: Duffy
mesh_terms: D000368:Aged; D000704:Analysis of Variance; D000789:Angina, Unstable / Q000628:therapy; D015906:Angioplasty, Balloon, Coronary; D001315:Australia / Q000453:epidemiology; D019917:Blood Vessel Prosthesis Implantation; D020099:Coated Materials, Biocompatible / Q000627:therapeutic use*; D003327:Coronary Disease / Q000628:therapy; D023903:Coronary Restenosis / Q000453:epidemiology* / Q000209:etiology* / Q000628:therapy; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D015994:Incidence; D008297:Male; D008670:Metals / Q000009:adverse effects; D008875:Middle Aged; D009203:Myocardial Infarction / Q000628:therapy; D012008:Recurrence; D012042:Registries; D012086:Reoperation; D012107:Research Design; D015607:Stents / Q000009:adverse effects*; D016896:Treatment Outcome
chemical_list: D020099:Coated Materials, Biocompatible; D008670:Metals