Longer-term outcomes of paclitaxel stent implantation as an initial treatment strategy for sirolimus-eluting stent restenosis.
OBJECTIVE
The goal of this study was to determine the long-term clinical outcomes after an initial strategy of paclitaxeleluting stent (PES) implantation for de novo sirolimus-eluting stent (SES) restenosis.


BACKGROUND
The optimal treatment of drug-eluting stent (DES) restenosis is unknown.


METHODS
Consecutive patients undergoing PES implantation for SES restenosis were identified. Patients were considered eligible for inclusion if: (1) the initial target lesion for the SES was de novo; (2) the SES restenotic lesion had not been previously treated; and (3) at least 1 year had passed since the PES implantation.


RESULTS
A total of 130 consecutive patients with 142 restenotic SES lesions were treated with PES. Mean patient age was 66.4 +/- 11 years, diabetes was present in 37.1%, and the target lesion was focal in 67.8%. Over a median of 453 days (range, 365-789 days), out-ofhospital major adverse cardiac events occurred in 33 patients (25.4%). Out-of-hospital death occurred in 2 patients (due to sepsis and cancer), myocardial infarction in 1 patient (0.8%), and target lesion revascularization (TLR) in 30 patients (23.8%). There were no episodes of stent thrombosis. There was no difference in freedom from TLR between lesions with focal or non-focal pattern (log rank p = 0.52), although the time to recurrence was later in focal compared to non-focal lesions (323 +/- 26 days versus 216 +/- 17 days; p = 0.02).


CONCLUSIONS
An initial treatment strategy of PES implantation for SES restenosis appears safe and provides reasonable outcomes at more than 1-year follow up.
Levisay
Justin P
JP
Northshore University HealthSystems, Evanston Hospital, Evanston, IL 60201, USA. JLevisay@northshore.org
Price
Matthew J
MJ
Shaba
Wisam
W
Lee
Steve S
SS
Stinis
Curtiss P
CP
Miller
Latrice
L
Teirstein
Paul S
PS
D000368:Aged; D015906:Angioplasty, Balloon, Coronary / Q000009:adverse effects / Q000401:mortality*; D000972:Antineoplastic Agents, Phytogenic / Q000008:administration & dosage; D017023:Coronary Angiography; D003324:Coronary Artery Disease / Q000000981:diagnostic imaging / Q000401:mortality / Q000628:therapy; D023903:Coronary Restenosis / Q000000981:diagnostic imaging / Q000401:mortality / Q000628:therapy; D018572:Disease-Free Survival; D004351:Drug Resistance; D054855:Drug-Eluting Stents / Q000009:adverse effects / Q000706:statistics & numerical data*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D017239:Paclitaxel / Q000008:administration & dosage*; D011237:Predictive Value of Tests; D019233:Retreatment / Q000706:statistics & numerical data; D020123:Sirolimus / Q000008:administration & dosage*; D016019:Survival Analysis; D016896:Treatment Outcome
D000972:Antineoplastic Agents, Phytogenic; D017239:Paclitaxel; D020123:Sirolimus