title: Mid-Term Follow-Up of Drug-Eluting Stenting for In-Stent Restenosis: Bare-Metal Stents versus Drug-Eluting Stents.
abstract: BACKGROUND
  Despite major advances in percutaneous coronary intervention (PCI), in-stent restenosis (ISR) remains a therapeutic challenge. We sought to compare the mid-term clinical outcomes after treatment with repeat drug-eluting stent (DES) implantation ("DES sandwich" technique) with DES placement in the bare-metal stent (DES-in-BMS) in a "real world" setting.
  
  
  METHODS
  We retrospectively identified and analyzed clinical and angiographic data on 194 patients previously treated with the DES who underwent repeat PCI for ISR with a DES or a BMS. ISR was defined, by visual assessment, as a luminal stenosis greater than 50% within the stent or within 5 mm of its edges. We recorded the occurrence of major adverse cardiac events (MACE), defined as cardiac death, non-fatal myocardial infarction, and the need for target vessel revascularization (TVR).
  
  
  RESULTS
  Of the 194 study participants, 130 were men (67.0%) and the mean ± SD of age was 57.0 ± 10.4 years, ranging from 37 to 80 years. In-hospital events (death and Q-wave myocardial infarction) occurred at a similar frequency in both groups. Outcomes at twelve months were also similar between the groups with cumulative clinical MACE at one-year follow-up of 9.6% and 11.3% in the DES-in-BMS and the DES-in-DES groups, respectively (p value = 0.702). Although not significant, there was a trend toward a higher TVR rate in the intra-DES ISR group as compared to the intra-BMS ISR group (0.9% BMS vs. 5.2% DES; p value = 0.16).
  
  
  CONCLUSIONS
  Our study suggests that the outcome of the patients presenting with ISR did not seem to be different between the two groups of DES-in-DES and DES-in-BMS at one-year follow-up, except for a trend toward more frequent TVR in the DES-in-DES group. Repeat DES implantation for DES restenosis could be feasible and safe with a relatively low incidence of MACE at mid-term follow-up.
authors: Tehran Heart Center, Tehran University of Medical Sciences, Tehran, Iran.
authors: Negar
authors: N
authors: Faramarzi
authors: Mojtaba
authors: M
authors: Salarifar
authors: Seyed Ebrahim
authors: SE
authors: Kassaian
authors: Ali Mohammad Haji
authors: AM
authors: Zeinali
authors: Mohammad
authors: M
authors: Alidoosti
authors: Hamidreza
authors: H
authors: Pourhoseini
authors: Ebrahim
authors: E
authors: Nematipour
authors: Mohammad Reza
authors: MR
authors: Mousavi
authors: Hamidreza
authors: H
authors: Goodarzynejad
keywords: Angioplasty; Drug-eluting stent; Graft occlusion, vascular; Prognosis; Treatment outcome
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