In Stent Restenosis (Isr) in Patients Undergoing Percutaneous Coronary Intervention (Pci) for Coronary Artery Disease (Cad)

Abstract

Objective: To study the frequency of In-Stent Restenosis and its treatment in patients undergoing Percutaneous Coronary Intervention for coronary artery disease.
 Study Design: Descriptive cross sectional study.
 Place and Duration of Study: Department of Cardiology, Armed Forces Institute of Cardiology & National Institute of Heart disease (AFIC/NIHD) Rawalpindi, from Jul 2017 to Jul 2019.
 Methodology: All the patients who underwent Percutaneous Coronary Intervention for Coronary Artery Disease at our institute were considered for this study. A consecutive sampling method was used and inclusion/exclusion criteria was applied. Following data was obtained; 1) Demographic information and clinical risk factors like history of hypertension, hyperlipidemia, diabetes mellitus, smoking, coronary artery disease characteristics(number of diseased arteries, bifurcation lesions, calcification, chronic total occlusions-CTO and tortuosity) 3), Stent factors (under expansion, fracture, longitudinal miss, stent gap). Data recording, storage, assessment and analysis was done by using SPSS software version 21.
 Results: Among 1332 cases, 50 had In-Stent Restenosis with overall prevalence of 3.75%. Mean age of the patients with In-Stent Restenosis was 58.76 (± 9.97), with 45 (90%) male and 5 (10%) female. Diabetes Mellitus was the commonest risk factor (22.9%) followed by Hypertension (18%). Sixty four percent of the patients (n=32) had Single Vessel Coronary Artery Disease, 14 (28%) had Double Vessel Coronary Artery Disease and 4 (8%) had Tripple Vessel Coronary Artery Disease. Left Anterior Descending was the commonest coronary artery that developed In-Stent Restenosis, followed by Right Coronary Artery and Left Circumflex respectively. Previously deployed stents which developed In-Stent Restenosis showed longitudinal geographical miss in 16%, stent under expansion in 6% and stent gap in 4%. There was statistically significant association (p-value=0.02) between stent length and frequency of In-Stent Restenosis and it was commonest in stents longer than 30 mm. Eighty six percent(n=43) of In-Stent Restenosis cases in our study group was treated with Drug Eluting Stent followed by Drug Eluting Balloon in 32% and Plain Old Balloon Angioplasty in 22%.
 Conclusion: History of diabetes mellitus and greater stent length were major risk factors in developing In-Stent Restenosis in our study. DES was the commonest treatment modality used.Keywords: , , .

Frequency of in Stent Restenosis in Diabetic and Patients Undergoing PCI at Tertiary Care Cardiac Center

“…There was a significant association between diabetes and in-stent restenosis with p-value <0.05. A study conducted by raja W et al [26] regarding prevalence of ISR in patients undergoing primary PCI, reported that the overall prevalence of ISR was 3.75% and diabetes mellitus was the commonest risk factor found in In-Stent restenosis patients 22.9%.…”

In Stent Restenosis (Isr) in Patients Undergoing Percutaneous Coronary Intervention (Pci) for Coronary Artery Disease (Cad)

“…Despite the advent of medication-eluting stents (DES) and further developed stent design, the rates of ISR in patients treated with DES are as high as 10%. Specifically, the widespread adoption of DES for small arteries, long lesions, complex coronary lesions, diabetes, and history of bypass surgery has been the trigger for significant numbers of patients re-presenting with DES restenosis in contemporary clinical practice (9). Coronary intervention or percutaneous coronary intervention (PCI) is an important therapeutic strategy for coronary artery disease (CAD) (1), and in-stent restenosis (ISR) is the most well-known complication of PCI, which occurs in 3%-20% of patients undergoing coronary stent implantation.…”