Coronary stenting with the sirolimus-eluting stent in patients with restenosis after intracoronary brachytherapy: results from the prospective multicentre German Cypher Stent Registry.
BACKGROUND
Treatment of restenosis following intracoronary brachytherapy (ICB) is still a challenging problem. Implantation of sirolimus-eluting stents (SES) in this setting may be an option to be evaluated.


RESULTS
We analysed the prospective multicentre SES registry, the German Cypher Stent Registry. 7,445 patients treated with an SES during percutaneous coronary intervention (PCI) were registered. Out of these patients, 61 (0.8%) were treated for restenosis after ICB: 56 patients with completed follow-up could be evaluated. Median age was 65 years, with 80% male patients. 48% of patients had a prior myocardial infarction and 25% had already coronary bypass surgery (CABG). Type B2 lesion was present in 40% and type C lesion in 22.4%. Event rates from SES implantation until 6.6 months follow-up were death 0%, myocardial infarction 3.6%, stroke 2.1%. Target vessel revascularization rate (TVR) was 16.4%, and major adverse cardiovascular or cerebral events (MACCE) or TVR occurred in 17.9% of patients. This TVR rate was higher compared with that of other patients treated with an SES: 8.4% (P = 0.04). During 65 months follow-up MACCE or TVR occurred in 44.6% of patients.


CONCLUSIONS
The treatment of lesions after ICB occurred in 0.8% out of all patients treated with an SES. Clinical event rates during early follow-up were low. However, the TVR rate was 16.4%, which was significantly higher when compared with other SES-treated patients (8.4%, P = 0.04). The treatment of restenosis after ICB with SES seems to be safe and reasonably effective; however, there might be a late catch-up phenomenon.
Zahn
Ralf
R
Med. Klinik B, Kardiologie/Pneumologie/Angiologie/Internistische Intensivmedizin, Herzzentrum Ludwigshafen, Bremserstrasse 79, 67063 Ludwigshafen, Germany. erzahn@aol.com
Hamm
Christian W
CW
Zeymer
Uwe
U
Richardt
Gert
G
Kelm
Malte
M
Levenson
Benny
B
Bonzel
Tassilo
T
Tebbe
Ulrich
U
Sabin
Georg
G
Nienaber
Christoph A
CA
Pfannebecker
Thomas
T
Senges
Jochen
J
D000368:Aged; D001807:Blood Vessel Prosthesis / Q000706:statistics & numerical data*; D001918:Brachytherapy / Q000706:statistics & numerical data*; D023903:Coronary Restenosis / Q000453:epidemiology* / Q000628:therapy*; D054855:Drug-Eluting Stents / Q000706:statistics & numerical data*; D005260:Female; D005858:Germany / Q000453:epidemiology; D006801:Humans; D008297:Male; D008875:Middle Aged; D015995:Prevalence; D011446:Prospective Studies; D012042:Registries; D018570:Risk Assessment; D012307:Risk Factors; D020123:Sirolimus / Q000008:administration & dosage*; D016896:Treatment Outcome
D020123:Sirolimus