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

Abstract

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.

Two-stent strategy for renal artery stenosis with bifurcation lesion

“…In that study, no evidence of in-stent restenosis was found in 25 patients with small renal arteries after coronary DES treatment during a followup period of six months (Li et al, 2009). The safety and efficacy of coronary DES in renal artery have also been reported by Ge et al (2010).…”

Management of drug eluting stent in‐stent restenosis: A systematic review and meta‐analysis

“…A). Twenty‐five single arm and 13 comparative studies with a total of 7,474 patients with DES ISR were included in this analysis . Of the 13 comparative studies (including 3,642 patients with DES ISR), 11 studies compared outcomes between repeat DES and BA, 3 studies compared DEB and BA, and only one study compared DEB with DES (ISAR DESIRE 3) for the management of DES ISR.…”

Clinical Outcomes of Drug-Eluting versus Bare-Metal In-Stent Restenosis after the Treatment of Drug-Eluting Stent or Drug-Eluting Balloon: A Systematic Review and Meta-Analysis

“…Although the use of drug-eluting stents (DES) has significantly reduced the rates of in-stent restenosis (ISR) compared with bare-metal stents (BMS) [1,2], DES related ISR (DES-ISR) still occurs and the prognosis of patients with DES-ISR, which may be different from patients with BMS-ISR due to the different pathological features, remains unclear [3,4]. Recently, several studies investigated the long-term clinical outcomes of DES-ISR versus BMS-ISR after treated by DES or drug-eluting balloon (DEB), but the results were inconsistent [7][8][9][10][11][12][13][14][15][16][17][18][19][20][21][22][23][24][25]. erefore, we enrolled these studies to conduct a meta-analysis to evaluate the results.…”