title: Decreased risk of stent fracture-related restenosis between paclitaxel-eluting stents and sirolimus eluting stents: results of long-term follow-up.
abstract: OBJECTIVE
  To compare the outcomes between paclitaxel-eluting stents (PES) and sirolimus-eluting stents (SES) for the treatment of drug-eluting stent (DES) fracture.
  
  
  BACKGROUND
  DES fracture is considered as an important predictor of in-stent restenosis (ISR). However, little data are available evaluating the optimal treatment for this complication of coronary stenting.
  
  
  METHODS
  From January 1, 2004 to December 31, 2008, patients with DES ISR treated with a second DES were identified and evaluated for stent fracture. Stent fracture was defined by the presence of strut separation in multiple angiographic projections, assessed by two independent reviewers. Target lesion revascularization (TLR) at 6 and 12 months were the primary end points.
  
  
  RESULTS
  Of 131 lesions with DES ISR treated with a second DES, we found 24 patients (24 lesions, 18.2%) with angiographically confirmed stent fracture. Of these, 20 patients (20 lesions) treated with either PES (n = 11/55%) or SES (n = 9/45%) were included in the study. TLR at 6 months occurred in 9% of patients treated with PES and 22% of those treated with SES (P = 0.41). After 12 months, TLR was 9% and 55.5%, respectively (P = 0.024).
  
  
  CONCLUSIONS
  This study demonstrates a high incidence of stent fracture in patients presenting with DES ISR in need of further treatment with another DES. The suggested association between treatment of stent fracture-associated DES ISR with PES as compared with SES, and better long-term outcomes, is in need of confirmation by larger prospective registries and randomized trials.
authors.affiliation: Peter Munk Cardiac Centre, Interventional Cardiology Program, Division of Cardiology, University Health Network, Toronto, Ontario, Canada.
authors.forename: Xavier
authors.initials: X
authors.lastname: Freixa
authors.forename: Ali S
authors.initials: AS
authors.lastname: Almasood
authors.forename: Sohail Q
authors.initials: SQ
authors.lastname: Khan
authors.forename: Rodrigo
authors.initials: R
authors.lastname: Wainstein
authors.forename: Azriel
authors.initials: A
authors.lastname: Osherov
authors.forename: Karen
authors.initials: K
authors.lastname: Mackie
authors.forename: Peter H
authors.initials: PH
authors.lastname: Seidelin
authors.forename: Vladimír
authors.initials: V
authors.lastname: Džavík
mesh_terms: D000368:Aged; D015906:Angioplasty, Balloon, Coronary / Q000009:adverse effects* / Q000295:instrumentation*; D016009:Chi-Square Distribution; D017023:Coronary Angiography; D023903:Coronary Restenosis / Q000000981:diagnostic imaging / Q000209:etiology / Q000628:therapy*; D023921:Coronary Stenosis / Q000000981:diagnostic imaging / Q000628:therapy*; D054855:Drug-Eluting Stents; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009864:Ontario; D017239:Paclitaxel / Q000008:administration & dosage*; D011474:Prosthesis Design; D011475:Prosthesis Failure; D012189:Retrospective Studies; D018570:Risk Assessment; D012307:Risk Factors; D020123:Sirolimus / Q000008:administration & dosage*; D013997:Time Factors; D016896:Treatment Outcome
chemical_list: D017239:Paclitaxel; D020123:Sirolimus