Contemporary treatment of in-stent restenosis and the incidence of recurrent in-stent restenosis in the era of drug-eluting stents.
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.
Ajani
Andrew E
AE
Department of Cardiology, Royal Melbourne Hospital, Melbourne, Australia. andrew.ajani@mh.org.au
Yan
Bryan P
BP
Clark
David J
DJ
Eccleston
David
D
Walton
Anthony
A
Lew
Robert
R
Meehan
Adam
A
Brennan
Angela
A
Reid
Chris
C
Duffy
Stephen J
SJ
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
D020099:Coated Materials, Biocompatible; D008670:Metals