Directional coronary atherectomy vs. rotational atherectomy for the treatment of in‐stent restenosis of native coronary arteries

Sánchez, Pedro L.; Rodriguez-Alemparte, Máximo; Colón-Hernández, Pedro; Pomerantsev, Eugene; Inglessis, Ignacio; Mahdi, Nasser A; Leinbach, Robert C.; Palacios, Igor F.

doi:10.1002/ccd.10399

Cited by 7 publications

(2 citation statements)

References 28 publications

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“… 45) Directional atherectomy was also assessed in early studies, but this was soon abandoned because it was not well suited for small or distal vessels, which are common locations for ISR. 46) The excimer laser showed good results in some cases but eventually proved to have poorer ablation capability compared with rotational atherectomy. 45) …”

Section: Treatment Of Isrmentioning

confidence: 99%

Current Management of In-Stent Restenosis

Her

Shin

2018

Korean Circ J

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Despite the advent of the drug-eluting stents (DES) and improved stent design, in-stent restenosis (ISR) remains a challenging problem. The currently available options for treatment of ISR include angioplasty alone, repeat stenting with DES or drug-coated balloons. Several recent studies have compared the available options for treating ISR in an attempt to identify the preferred therapeutic strategy. In this review, we will discuss the currently available therapeutic strategies for the management of patients with ISR and the evidence supporting their use.

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Section: Treatment Of Isrmentioning

confidence: 99%

Current Management of In-Stent Restenosis

Her

Shin

2018

Korean Circ J

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“…In a nonrandomized study of 119 patients with ISR of native coronary arteries, 58 underwent DCA and 61 underwent rotablation for symptomatic coronary ISR [21]. Adjunctive balloon angioplasty at relatively high pressures was performed in both groups.…”

Section: Directional Coronary Atherectomymentioning

confidence: 99%

Classification and Current Treatment Options of In-Stent Restenosis

Ong

Aoki

McFadden

et al. 2004

Herz

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Coronary stent implantation is currently performed in > 80% of percutaneous coronary interventions. Its main late complication is the development of in-stent restenosis (ISR), occurring in 10-80% of lesions treated in daily practice. The classification by Mehran et al. is most commonly used. Current therapeutic options to treat ISR include repeat balloon angioplasty, repeat stenting, cutting balloon angioplasty, directional coronary atherectomy, rotational coronary atherectomy, brachytherapy, and drug-eluting stents (DES). DES have been effective in reducing binary restenosis in de novo lesions in randomized controlled trials. The novel use of DES to treat ISR has been shown to be safe and effective in multiple studies involving sirolimus- and paclitaxel-eluting stents. As DES implantation becomes more widespread, ISR in DES is emerging as a new problem. The use of debulking techniques to treat ISR in DES is to be cautioned against. In this new era, the optimal treatment of this new problem is currently unknown. We await further data to see whether repeat DES implantation may help solve this vexing clinical problem.

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Current understanding of coronary in-stent restenosis

Schiele

2005

ZS Kardiologie

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In-stent restenosis is the limiting entity following coronary stent implantation. It is associated with significant morbidity and cost and thus represents a major clinical and economical problem. Worldwide, approximately 250 000 in-stent restenotic lesions per year have to be dealt with. The pathophysiology of instent restenosis is multifactorial and comprises inflammation, smooth muscle cell migration and proliferation and extracellular matrix formation, all mediated by distinct molecular pathways. Instent restenosis has been recognised as very difficult to manage, with a repeat restenosis rate of 50% regardless of the mechanical angioplasty device used. Much more favourable results were reported for the adjunctive irradiation of the in-stent restenotic lesion, with a consistent reduction of the incidence of repeat in-stent restenosis by 50%. Data from the first clinical trials on drug-eluting stents for the treatment of in-stent restenosis have shown very much promise yielding this strategy likely to become the treatment of choice. This review outlines the histological and molecular findings of the pathophysiology, the epidemiology, the predictors and the diagnostic work-up of in-stent restenosis and puts emphasis on the various treatment options for its prevention and therapy.

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Directional coronary atherectomy vs. rotational atherectomy for the treatment of in‐stent restenosis of native coronary arteries

Cited by 7 publications

References 28 publications

Current Management of In-Stent Restenosis

Current Management of In-Stent Restenosis

Classification and Current Treatment Options of In-Stent Restenosis

Current understanding of coronary in-stent restenosis

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