Therapeutic strategy for in-stent restenosis based on the restenosis pattern after drug-eluting stent implantation.
OBJECTIVE
The aim of this study was to evaluate the outcomes of repeated percutaneous coronary intervention (PCI) based on the restenosis pattern in drug-eluting stent (DES) failure.


METHODS
From April 2003 to March 2006, all 67 patients (67 lesions) at our 3 centers who had DES in-stent restenosis (ISR) were enrolled. The patients were divided into 3 groups: group I had focal edge restenosis, group II had focal body restenosis, and group III had non-focal restenosis. All patients were treated with conventional PCI including plain old balloon angioplasty (POBA), cutting balloon angioplasty (CBA), and repeated DES implantation (Re-DES). Angiographic and clinical one year follow-up results for the 3 groups were evaluated.


RESULTS
Sixteen patients were enrolled in group I, 36 in group II, and 15 in group III. Baseline clinical and angiographic characteristics and the proportion of patients in each group receiving each type of treatment strategy were not significantly different among the groups. Within each group, a comparison of angiographic and clinical outcomes for each therapeutic modality revealed that restenosis rates were not statistically different. Although rates of major adverse cardiac events (MACE) were not statistically different between groups I and II, in group III, MACE were 3-fold higher for the POBA (4/4, 100.0%) and CBA (4/4, 100.0%) subgroups than for Re-DES (1/3, 33.3%) (p=0.06), but the differences did not reach statistical significance.


CONCLUSIONS
THE PRESENT STUDY SUGGESTS THAT TREATMENT OF DES ISR SHOULD BE INDIVIDUALIZED ACCORDING TO RESTENOSIS PATTERN: any PCI strategy appears appropriate for focal ISR patterns, while Re-DES might be a better choice for non-focal ISR patterns.
Kim
Ki-Hun
KH
Division of Cardiology, Department of Internal Medicine, College of Medicine, Inje University, Busan Paik Hospital, Busan, Korea.
Kim
Doo-Il
DI
Kim
Il-Hwan
IH
Kim
Jong-Yoon
JY
Han
Yang-Chun
YC
Seol
Sang-Hoon
SH
Kim
Ung
U
Yang
Tae-Hyun
TH
Kim
Dae-Kyeong
DK
Kim
Dong-Soo
DS
Lee
Sang-Hee
SH
Park
Jong-Seon
JS
Kim
Young-Jo
YJ
Shin
Dong-Gu
DG
Cho
Yoon-Kyung
YK
Nam
Chang-Wook
CW
Hur
Seung-Ho
SH
Kim
Kwon-Bae
KB