title: Sirolimus-eluting stent implantation for bare-metal in-stent restenosis: is there any evidence for a late catch-up phenomenon?
abstract: OBJECTIVE
  In-stent restenosis occurs not infrequently after intracoronary implantation of bare-metal stents. Many techniques have been proposed for the treatment of in-stent restenosis, but drug-eluting stents seem to provide the best early and mid-term results. We aimed to appraise whether the effectiveness of drug-eluting stents for in-stent restenosis is maintained even in the long term.
  
  
  METHODS
  Participants in this prospective multicenter study were patients with in-stent restenosis treated with sirolimus-eluting stents. The primary endpoint was freedom from major adverse cardiovascular events (i.e. death, nonfatal myocardial infarction, target vessel revascularization, or stent thrombosis) in the long term (> or =24 months), with 6-month angiography planned for all patients.
  
  
  RESULTS
  A total of 271 consecutive patients were enrolled (332 sirolimus-eluting stents). Procedural success was obtained in all patients, with no case of in-hospital death, acute/subacute stent thrombosis, stroke, or urgent coronary bypass. Survival free from major cardiovascular events decreased progressively from 98.8% at 1 month, to 95.7, 83.7, 75.4, and 65.8% at 6, 12, 24, and 30 months, respectively. A similar attrition in freedom from repeat target vessel was found from 97.6% at 6 months to 76.7% at 30 months. A total of four possible and one definite stent thromboses (2.6%) were noted, all occurring several months after clopidogrel discontinuation and in patients on life-long aspirin.
  
  
  CONCLUSIONS
  The present study supports the mid-term safety and effectiveness of sirolimus-eluting stents for the treatment of in-stent restenosis in comparison with the other available treatments. Whether the late catch-up phenomenon observed in repeat target revascularization and stent thrombosis is an incidental finding deserves further rigorous scrutiny.
authors.affiliation: Division of Cardiology, University of Turin, Turin, Italy. isheiban@yahoo.com
authors.forename: Imad
authors.initials: I
authors.lastname: Sheiban
authors.forename: Amedeo
authors.initials: A
authors.lastname: Chiribiri
authors.forename: Stefano
authors.initials: S
authors.lastname: Galli
authors.forename: Giuseppe
authors.initials: G
authors.lastname: Biondi-Zoccai
authors.forename: Piero
authors.initials: P
authors.lastname: Montorsi
authors.forename: Serena
authors.initials: S
authors.lastname: Beninati
authors.forename: Franco
authors.initials: F
authors.lastname: Fabbiocchi
authors.forename: Claudio
authors.initials: C
authors.lastname: Moretti
authors.forename: Pierluigi
authors.initials: P
authors.lastname: Omedè
authors.forename: Daniela
authors.initials: D
authors.lastname: Trabattoni
authors.forename: Marzia
authors.initials: M
authors.lastname: Lotrionte
authors.forename: Gian Paolo
authors.initials: GP
authors.lastname: Trevi
authors.forename: Antonio L
authors.initials: AL
authors.lastname: Bartorelli
mesh_terms: D019917:Blood Vessel Prosthesis Implantation / Q000295:instrumentation*; D020099:Coated Materials, Biocompatible; D017023:Coronary Angiography; D023903:Coronary Restenosis / Q000000981:diagnostic imaging / Q000209:etiology / Q000601:surgery*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007166:Immunosuppressive Agents / Q000494:pharmacology*; D008297:Male; D008670:Metals / Q000009:adverse effects*; D008875:Middle Aged; D011446:Prospective Studies; D020123:Sirolimus / Q000494:pharmacology*; D013997:Time Factors; D016896:Treatment Outcome
chemical_list: D020099:Coated Materials, Biocompatible; D007166:Immunosuppressive Agents; D008670:Metals; D020123:Sirolimus