title: Optimal treatment of recurrent restenosis lesions after drug-eluting stent implantation for in-stent restenosis lesions.
abstract: OBJECTIVE
  Although the outcomes of various treatments for in-stent restenosis (ISR) after drug-eluting stent (DES) implantation have been reported, the optimal treatment of recurrent ISR lesions after DES implantation for ISR lesions was unknown. This study compared the efficacy between DES implantation and balloon angioplasty (BA) for recurrent ISR lesions after DES implantation.
  
  
  RESULTS
  From 2003 to 2010, DES were implanted in 1,101 ISR lesions, of which 148 recurrent ISR lesions (142 patients) were treated with BA (76 lesions, 72 patients) and DES implantation (72 lesions, 70 patients). Clinical outcomes were evaluated for major adverse cardiac events (MACE), including a composite of death, myocardial infarction, and target lesion revascularisation (TLR). Angiographic outcomes were evaluated by follow-up angiography at six to eight months after procedure. At angiographic follow-up (94.4% of all patients), the binary restenosis rate was significantly lower in DES implantation (25.0%) than in BA (64.4%, p<0.001), whereas late lumen loss was similar between DES implantation and BA (0.80±0.78 mm vs. 0.87±0.79 mm, p=0.60). The incidence of four-year MACE was significantly higher in BA (75.2%) than in DES implantation (45.8%, p<0.001), mainly because of the lower TLR rate in DES implantation (60.5% vs. 27.6%, p<0.001). Multivariate analysis revealed that BA is an independent predictor of TLR, followed by non-focal lesion, non-intravascular ultrasound guidance, and dyslipidaemia.
  
  
  CONCLUSIONS
  In the treatment of recurrent ISR lesions, DES implantation is markedly more effective with a lower incidence of TLR compared to BA.
authors.affiliation: Department of Cardiology, Kurashiki Central Hospital, Kurashiki, Japan.
authors.forename: Shunsuke
authors.initials: S
authors.lastname: Kubo
authors.forename: Kazushige
authors.initials: K
authors.lastname: Kadota
authors.forename: Suguru
authors.initials: S
authors.lastname: Otsuru
authors.forename: Daiji
authors.initials: D
authors.lastname: Hasegawa
authors.forename: Yoshikazu
authors.initials: Y
authors.lastname: Shigemoto
authors.forename: Seiji
authors.initials: S
authors.lastname: Habara
authors.forename: Takeshi
authors.initials: T
authors.lastname: Tada
authors.forename: Hiroyuki
authors.initials: H
authors.lastname: Tanaka
authors.forename: Yasushi
authors.initials: Y
authors.lastname: Fuku
authors.forename: Harumi
authors.initials: H
authors.lastname: Katoh
authors.forename: Tsuyoshi
authors.initials: T
authors.lastname: Goto
authors.forename: Kazuaki
authors.initials: K
authors.lastname: Mitsudo
mesh_terms: D000800:Angioplasty, Balloon; D015906:Angioplasty, Balloon, Coronary; D017023:Coronary Angiography; D023903:Coronary Restenosis; D054855:Drug-Eluting Stents; D006801:Humans