title: Drug-eluting stents or balloon angioplasty for drug-eluting stent-associated restenosis: An observational follow-up study of first-time versus repeated restenosis.
abstract: BACKGROUND
  The treatment of patients with repeated drug-eluting stent-in stent restenosis (DES-ISR) remains a challenge and a burdensome clinical problem.
  
  
  METHODS
  Over a 3-year period, 130 lesions in 123 patients who underwent target lesion revascularization (TLR) for DES restenosis were included in the study. They were classified into two main groups: the first group having first-time DES-ISR (n= 84), and the second group having rerestenosis of DES-treated DES-ISR (n= 39). Further classification according to the treatment strategy yielded four subgroups: balloon angioplasty (BA) in first-time DES-ISR (n= 66), re-DES in the same group (n= 22), BA in rerestenosis of DES-treated DES-ISR (n= 30), and re-DES in the same group (n= 10). Angiographic follow-up was planned at 1 year, and clinical follow-up for re-TLR up to 2 years later.
  
  
  RESULTS
  The mean duration of clinical follow-up was 24.8 ± 9.7 months. The angiographic follow-up data were obtained for 108 patients (87.8%) at 1 year. Among patients treated for first-time DES-ISR, late lumen loss (0.65 ± 0.83 mm and 1.02 ± 0.52 mm,p= 0.02) and binary restenosis rates (25% and 49.1%,p= 0.05) were significantly less in those undergoing re-DES compared with BA. This benefit was not evident in patients having rerestenosis of DES-treated DES-ISR. Re-TLR at 2 years was significantly less in the re-DES group compared with BA (log rankp= 0.038) in first-time DES-ISR patients, while no significant difference (log rankp= 0.58) was observed in those having rerestenosis of DES-treated DES-ISR.
  
  
  CONCLUSIONS
  While a strategy of re-DES would be better than BA in first-time DES-ISR, this could not be extrapolated to rerestenosis cases.
authors.affiliation: Department of Cardiovascular Medicine, Asyut University Hospital, Asyut, aEgypt; Department of Cardiovascular Medicine, Kokura Memorial Hospital, Kitakyushu, bJapan.
authors.forename: Mohamed Aboel-Kassem F
authors.initials: MA
authors.lastname: Abdelmegid
authors.affiliation: Department of Cardiovascular Medicine, Asyut University Hospital, Asyut, aEgypt.
authors.forename: Tarek A N
authors.initials: TA
authors.lastname: Ahmed
authors.affiliation: Department of Cardiovascular Medicine, Kokura Memorial Hospital, Kitakyushu, bJapan.
authors.forename: Masashi
authors.initials: M
authors.lastname: Kato
authors.affiliation: Department of Cardiovascular Medicine, Kokura Memorial Hospital, Kitakyushu, bJapan.
authors.forename: Kenji
authors.initials: K
authors.lastname: Ando
authors.affiliation: Department of Cardiovascular Medicine, Kokura Memorial Hospital, Kitakyushu, bJapan.
authors.forename: Takenori
authors.initials: T
authors.lastname: Domei
authors.affiliation: Department of Cardiovascular Medicine, Kokura Memorial Hospital, Kitakyushu, bJapan.
authors.forename: Masashi
authors.initials: M
authors.lastname: Iwabuchi
authors.affiliation: Department of Cardiovascular Medicine, Kokura Memorial Hospital, Kitakyushu, bJapan.
authors.forename: Masakiyo
authors.initials: M
authors.lastname: Nobuyoshi
keywords: Balloon angioplasty; Drug-eluting stents; In-stent restenosis; Rerestenosis