title: Choice of stent and outcomes after treatment of drug-eluting stent restenosis in highly complex lesions.
abstract: OBJECTIVE
  Our aim was to compare the outcomes of a same versus different drug-eluting stent (DES) implantation strategy for the treatment of DES instent restenosis (ISR).
  
  
  BACKGROUND
  The absence of clear data renders the treatment of DES ISR one of the most challenging situations in interventional cardiology.
  
  
  METHODS
  We identified all cases of DES ISR treated with a second DES between January 2004 and January 2009. The lesions were divided into those treated with the same DES as the initial one that restenosed and those treated with a different DES. The main end-point was repeat target lesion revascularization (TLR).
  
  
  RESULTS
  We included 116 patients with a total of 132 lesions. The patient population was highly complex: 55.5% with diabetes, 56% with type-C lesions, 15.9% with lesions previously stented with BMS and 18.2% with fluoroscopic evidence of stent fracture. A same and different stent strategy was conducted in 41 lesions (31%) and 91 lesions (69%), respectively. Overall TLR was 31.1% and occurred in 46.3% of patients treated with the same stent and 24.4% of those with a different stent (P = 0.012). Multivariable analysis found same stent strategy (OR 2.84, 95%CI 1.23-6.57;P = 0.014) and occurrence of stent fracture (OR 4.03, 95%CI 1.33-12.01;P = 0.012) to be the only independent predictors of TLR after a median follow-up of 20.4 [12.1-30.2] months.
  
  
  CONCLUSIONS
  In highly complex lesions, DES implantation for DES ISR is linked to a high need of future revascularization. An association between implanting a DES type other than the original and lower rate of TLR is suggested.
authors.affiliation: Peter Munk Cardiac Centre, University Health Network, Interventional Cardiology Program, Division of Cardiology, 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: Karen
authors.initials: K
authors.lastname: Mackie
authors.forename: Mark
authors.initials: M
authors.lastname: Osten
authors.forename: Douglas
authors.initials: D
authors.lastname: Ing
authors.forename: Christopher B
authors.initials: CB
authors.lastname: Overgaard
authors.forename: Eric M
authors.initials: EM
authors.lastname: Horlick
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; D016001:Confidence Intervals; D017023:Coronary Angiography / Q000379:methods; D023903:Coronary Restenosis / Q000000981:diagnostic imaging / Q000401:mortality / Q000628:therapy*; D023921:Coronary Stenosis / Q000000981:diagnostic imaging / Q000401:mortality / Q000628:therapy*; D054855:Drug-Eluting Stents / Q000706:statistics & numerical data*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D053208:Kaplan-Meier Estimate; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D016017:Odds Ratio; D009864:Ontario; D017239:Paclitaxel / Q000008:administration & dosage; D018579:Patient Selection; D011475:Prosthesis Failure; D012042:Registries; D019233:Retreatment; D012189:Retrospective Studies; D018570:Risk Assessment; D012720:Severity of Illness Index; D020123:Sirolimus / Q000008:administration & dosage; D016019:Survival Analysis; D016896:Treatment Outcome
chemical_list: D017239:Paclitaxel; D020123:Sirolimus