Comparison between balloon angioplasty and additional coronary stent implantation for the treatment of drug-eluting stent restenosis: 18-month clinical outcomes

Sardella, Gennaro; Colantonio, Riccardo; Luca, Leonardo De; Conti, Giulia; Roma, Angelo Di; Mancone, Massimo; Canali, Emanuele; Benedetti, Giulia; Fedele, Francesco

doi:10.2459/jcm.0b013e3283297c23

Cited by 11 publications

(27 citation statements)

References 35 publications

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“…However, sound scientific evidence on this issue is still missing. Five observational studies (11)(12)(13)(14)(15) provided information on the results of the switch strategy as compared with homo-DES implantation. These studies were highly heterogeneous but altogether included 487 patients (279 homo-DES, 208 hetero-DES).…”

Section: Previous Observational Studiesmentioning

confidence: 99%

Treatment of Drug-Eluting Stent Restenosis

Alfonso

2010

Journal of the American College of Cardiology

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Section: Previous Observational Studiesmentioning

confidence: 99%

Treatment of Drug-Eluting Stent Restenosis

Alfonso

2010

Journal of the American College of Cardiology

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“…However, this hypothesis has not been proved in clinical observation. Garg et al (2007), Cosgrave et al (2007b), and Sardella et al (2009) reported, respectively, a similar prognosis between homo-DES and hetero-DES strategies in the treatment of DES-ISR. In our study, there was a trend toward lower MACE rates in the DES-ISR patients using a different type of DES, but it did not reach statistical significance.…”

Section: Discussionmentioning

confidence: 94%

Efficacy and safety of drug-eluting stent implantation for the treatment of in-stent restenosis occurring within bare-metal stent and drug-eluting stent

Zhang

Zhou

et al. 2010

J. Zhejiang Univ. Sci. B

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Abstract:Objective: Although drug-eluting stent (DES) implantation is the primary treatment modality for bare-metal stent (BMS) in-stent restenosis (ISR), little is known about the efficacy and safety profile of DES in the treatment of DES-ISR. The goal of this study was to compare the clinical outcomes following DES treatment for BMS-ISR and DES-ISR. Methods: Rates of major adverse cardiac events (MACE) were compared in 97 consecutive patients who underwent DES implantation for the treatment of ISR (56 BMS-ISR and 41 DES-ISR) from January 2004 to December 2008. Results: Baseline clinical and procedural characteristics were comparable, except that the DES used in the BMS-ISR group was longer and had a larger diameter. The length of follow-up was (28.60±1.96) and (20.34±1.54) months for the BMS-ISR and DES-ISR groups, respectively. One patient (1.8%) experienced non-cardiac mortality and one (1.8%) had target-vessel revascularization (TVR) in the BMS-ISR group. In the DES-ISR group, three patients (7.3%) died of sudden death with a documented acute ST-segment elevation myocardial infarction, and three suffered TVR (7.3%). Kaplan-Meier analysis indicated that cumulative survival probability and MACE-free probability were both significantly lower for the DES-ISR group (log rank test P=0. 047 and P=0.005, respectively). In Cox regression analysis, DES-ISR remained an independent predictor for future MACE occurrence after adjustment for other factors (compared with BMS-ISR, risk ratio (RR)=8.743, 95% confidence interval (CI) 1. 54-49.54, P=0.014). Switching to a different type of DES to treat DES-ISR did not improve the prognosis. Conclusion: DES-ISR patients had a poorer prognosis than BMS-ISR patients after DES therapy.

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“…Both methods have been described as therapeutic breakthroughs in treating ISR. 2,6) Following the second PCI in 2003, however, the risks for ISR increased substantially due to the anatomic location (LAD), vessel geometry, the number and length of stents, and the presence of multiple overlaps. 7) Many studies have shown good results for the sandwich stenting technique in which a DES is implanted into a BMS ISR.…”

Section: Discussionmentioning

confidence: 99%

“…8,9) However, the data for such a procedure or any other intravascular intervention for that matter, in a DES ISR are still limited, although some reports are encouraging. 2,3,10) Paclitaxelcoated balloon catheters (DEB) offer more therapeutic advantages through immediate drug delivery on inflation, administration of a controlled dose, and homogeneity of vessel wall exposure without the disadvantages of a polymeric matrix that may induce inflammation and thrombosis. 11) In addition, intracoronary delivery of paclitaxel by a DEB catheter results in concentrations of the drug in vascular tissue that are high enough to have antiproliferative effects, thus leading to a significant reduction in neointimal proliferation.…”

Section: Discussionmentioning

confidence: 99%

“…Some studies have shown similar benefits between repeat DES stenting and conventional balloon angioplasty, whereas others have shown clear benefit for repeat DES stenting. [2][3][4] Percutaneous coronary balloon angioplasty has been largely superseded by repeat DES stenting or the 'sandwich stenting' technique, which is steadily gaining prominence. 5) We report a case of recalcitrant target lesion ISR which was successfully treated with drug-eluting balloon deployment.…”

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confidence: 99%

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Recurrent In-Stent Restenosis With Total Occlusion Remedied With Drug-Eluting Balloon Angioplasty A Case Report

Sabruddin¹,

Rosli²

2011

Int. Heart J.

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SummaryWe report a 69 year old female who presented with chest pain to the Emergency Department of the National Heart Institute Malaysia. Her history revealed that she had had 2 separate episodes of chest pain beginning in 2002, resulting in total occlusion of her mid left anterior descending artery (LAD) requiring percutaneous coronary intervention and stenting on both occasions. Cine angiogram on her current admission revealed recurrent target lesion in-stent restenosis with total occlusion of the distal LAD. Intravascular ultrasound revealed multilayered suboptimally deployed stents in the LAD. Successive drug-eluting balloon deployments resulted in sustained patency of the LAD after 1 year. (Int Heart J 2011; 52: 61-63) Key words: In-stent restenosis, Angioplasty, Drug-eluting balloon S tents are a crucial and indispensible tool for coronary interventionists. Their efficacy, however, has been limited by the development of in-stent restenosis (ISR) secondary to neointimal proliferation. 1) Drug-eluting stents (DES) have, in the past decade, markedly reduced the incidence of binary restenosis and repeat coronary revascularization.2) However, there is limited data on optimal management of DES restenosis. Some studies have shown similar benefits between repeat DES stenting and conventional balloon angioplasty, whereas others have shown clear benefit for repeat DES stenting.2-4) Percutaneous coronary balloon angioplasty has been largely superseded by repeat DES stenting or the 'sandwich stenting' technique, which is steadily gaining prominence.5) We report a case of recalcitrant target lesion ISR which was successfully treated with drug-eluting balloon deployment. A repeat coronary angiogram 1 year later revealed sustained target lesion patency and the patient remains symptom free. Case ReportA 69-year-old female with a history of diabetes, hypertension, and hyperlipidemia since 1990 and on regular medication, has had recurrent episodes of stable angina since 1997. She was put on aspirin but was never investigated for coronary artery disease due to patient refusal to consent for further evaluation or intervention.In 2002, she had a severe episode of chest pain which necessitated admission to a peripheral hospital from where she was eventually referred to the National Heart Institute in Kuala Lumpur. Her coronary angiogram then revealed a total occlusion of the left anterior descending artery (LAD) which was remedied with two overlapping Cypher DES extending from the mid to distal LAD (2.5 × 33 mm and 2.75 × 33 mm, Cypher TM sirolimus-eluting stent; Cordis Corp., Miami, FL) (Figures 1A-F). She was discharged with dual antiplatelet therapy.In 2003, she had recurrent symptoms and a repeat angiogram showed ISR with total occlusion of the mid LAD. Percutaneous coronary intervention (PCI) was attempted with a cutting balloon (3.0 × 15 mm, 3.5 × 15 mm and 4.0 × 10 mm; InterVentional Technologies Inc., San Diego, CA). This was followed by two bare-metal stents (BMS), Multi-Link Penta The PCI was complicated by perfor...

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Comparison between balloon angioplasty and additional coronary stent implantation for the treatment of drug-eluting stent restenosis: 18-month clinical outcomes

Abstract: In our registry, POBA seems to be as effective as other DES implantations in cases of DES ISR, especially in cases of focal type (Mehran classification IA, IC), in terms of long-term outcomes.

Cited by 11 publications

References 35 publications

Treatment of Drug-Eluting Stent Restenosis

Treatment of Drug-Eluting Stent Restenosis

Efficacy and safety of drug-eluting stent implantation for the treatment of in-stent restenosis occurring within bare-metal stent and drug-eluting stent

Recurrent In-Stent Restenosis With Total Occlusion Remedied With Drug-Eluting Balloon Angioplasty A Case Report

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