Long-Term Outcomes After Management of Restenosis or Thrombosis of Drug-Eluting Stents

Mishkel, Gregory; Moore, Anna L.; Markwell, Steve; Shelton, Marc; Shelton, Marc E.

doi:10.1016/j.jacc.2006.08.049

Cited by 86 publications

(75 citation statements)

References 13 publications

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“…842,843 Patients with clinical restenosis typically present with recurrent exertional angina, but 5% to 10% of patients present with acute MI and 25% with UA. 844,845 Factors associated with an increased risk of restenosis in various models include clinical setting (STEMI, ACS, daily angina), patient characteristics (diabetes, age Ͻ55 to 60 years, prior PCI, male sex, multivessel CAD), lesion location (unprotected left main, SVG), and procedural characteristics (minimum stent diameter Յ2.5 mm, total stent length Ն40 mm). 778,846 PCI strategies for treating restenosis after balloon angioplasty, BMS, and DES are reviewed in the following sections.…”

Section: Background and Incidencementioning

confidence: 99%

2011 ACCF/AHA/SCAI Guideline for Percutaneous Coronary Intervention

Levine

Bates²,

Blankenship³

et al. 2011

Circulation

1,887

567

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Section: Background and Incidencementioning

confidence: 99%

2011 ACCF/AHA/SCAI Guideline for Percutaneous Coronary Intervention

Levine

Bates²,

Blankenship³

et al. 2011

Circulation

1,887

567

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“…However, in the present study, lesion complexity, including quantitative coronary angiography results, was not less than that in previous registries. [4][5][6][7][8] Furthermore, routine angiographic follow-up might be associated with a higher incidence of focal restenosis. However, clinical presentation at follow-up angiography in the present study did not differ between patients with focal and non-focal restenosis.…”

Section: Angiographic Restenosis Pattern After Des Implantationmentioning

confidence: 99%

“…1-10 Large-scale randomized trials 1-3 have demonstrated a high proportion of focal restenosis after DES implantation, but on the other hand, recent real-world registries have shown that a significant proportion of restenosis is non-focal when DES are used in unselected lesions. [4][5][6][7][8] The present study evaluated angiographic patterns of restenosis after sirolimuseluting stent (SES) implantation in real-world practice in Japan. …”

mentioning

confidence: 99%

Angiographic Patterns of Restenosis After Sirolimus-Eluting Stent Implantation

Kitahara

Kobayashi

Takebayashi

et al. 2009

Circ J

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Circ J 2009; 73: 508 -511 lthough drug-eluting stents (DES) have significantly decreased the incidence of restenosis and the need for repeat revascularization, restenosis still occurs. 1-10 Large-scale randomized trials 1-3 have demonstrated a high proportion of focal restenosis after DES implantation, but on the other hand, recent real-world registries have shown that a significant proportion of restenosis is non-focal when DES are used in unselected lesions. [4][5][6][7][8] The present study evaluated angiographic patterns of restenosis after sirolimuseluting stent (SES) implantation in real-world practice in Japan. Methods PatientsA total of 1,693 lesions underwent SES implantation in 3 Japanese hospitals (Chiba University Hospital, Fukuyama Cardiovascular Hospital, and Chiba Cardiovascular Center) between August 2004 and April 2007. PCI was performed after written informed consent was given by the patients. All lesions underwent SES implantation according to current guidelines. 10 Angiographic follow-up was performed in 1,312 lesions (78%) at 6-9 months or earlier if noninvasive evaluation or clinical presentation suggested ischemia. Restenosis occurred in 124 lesions (9.5%) in 122 patients.Using a validated edge detection system (CMS, MEDIS, The Netherlands), quantitative coronary angiography was performed by an experienced cardiologist (H.K.). Standard qualitative and quantitative definitions and measurements were used. The outer diameter of the contrast-filled catheter was used as the calibration and the minimal lumen diameter was obtained from the single "worst" view. Angiographic restenosis was defined as diameter stenosis >50% within a previously stented segment (stent and 5 mm proximal and distal) on follow-up angiography. Cases of stent thrombosis were not considered as restenosis. The angiographic pattern of restenosis was classified as focal (≤10 mm in length), diffuse (restenosis >10 mm within the stent), proliferative (restenosis >10 mm in length extending outside the stent) or occlusive. 11 Focal restenosis was further categorized according to its position as proximal edge, intrastent, distal edge, or multi-focal. This study was approved by the local council on human research. Statistical AnalysisStatistical analysis was performed using StatView 5.0 (SAS Institute, Cary, NC, USA). Continuous variables are expressed as mean ± SD and categorical variables as frequency (%). Continuous variables were compared using Student's t-test. Categorical variables were compared with chi-square statistics; P<0.05 was considered significant.Multivariate logistic regression was used to identify independent predictors of non-focal restenosis. At this stage, the diffuse, proliferative, and occlusive restenosis patterns were combined into a single non-focal group in order to simplify and strengthen subsequent analysis. This was done (Received July 23, 2008; revised manuscript received September 30, 2008; accepted October 20, 2008; released online January 16, 2009 Angiographic Patterns of Restenosis After Sirol...

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“…Furthermore, current therapies for DES ISR or DES thrombosis are associated with a high long-term rate of MACE (42.9%). 18 The present study prospectively discovered that repeated SES implantation to treat SES restenosis is associated with a higher incidence of late restenosis, ischemiadriven TLR and MACE than SES implantation to treat BMS restenosis. The rates of re-restenosis, TLR or MACE in the present study were relatively similar to the findings of several retrospective studies.…”

Section: Discussionmentioning

confidence: 66%

Repeated Sirolimus-Eluting Stent Implantation to Treat Sirolimus-Eluting Stent and Bare-Metal Stent Restenosis

Nishihira

Shibata

Ishikawa

et al. 2010

Circ J

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Circulation Journal Official Journal of the Japanese Circulation Society http://www. j-circ.or.jp lthough drug-eluting stents (DES) have significantly decreased the incidence of in-stent restenosis (ISR) and the need for repeated revascularization compared with bare-metal stents (BMS), 1-5 DES restenosis still develops and ISR remains an important clinical issue especially for patients with highly complex lesions. 2-7 The increasing use of DES in complex settings coupled with the worldwide implantation of >10 million DES 6 implies that DES restenosis will become a significant global problem. However, an optimal treatment for DES restenosis remains unknown, and some experts propose repeated DES implantation. In contrast, several studies have shown the effectiveness of DES in patients with BMS ISR. 4,5 A recent study suggested different pathological features between intra-DES and intra-BMS restenotic tissue. 8 These 2 types of ISR lesion might have different biological responses and clinical outcomes after DES implantation. We therefore compared the clinical and angiographic outcomes of re-intervention with sirolimus-eluting stents (SES; Cypher, Cordis/Johnson & Johnson, Warren, NJ, USA) for ISR lesions that were originally treated with SES or BMS. Methods Study PatientsThe study population of this prospective single-center registry comprised 158 consecutive patients (179 lesions Background: In-stent restenosis (ISR) remains a persistent, unresolved issue even in the era of percutaneous coronary intervention (PCI) using drug-eluting stents. The present study compares the clinical and angiographic outcomes of using sirolimus-eluting stents (SES) for re-intervention against ISR that was originally treated with sirolimus-eluting or bare-metal (BMS) stents.

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Long-Term Outcomes After Management of Restenosis or Thrombosis of Drug-Eluting Stents

Abstract: Current treatments of ISR or STH in DES are associated with a high long-term rate of MACE.

Cited by 86 publications

References 13 publications

2011 ACCF/AHA/SCAI Guideline for Percutaneous Coronary Intervention

2011 ACCF/AHA/SCAI Guideline for Percutaneous Coronary Intervention

Angiographic Patterns of Restenosis After Sirolimus-Eluting Stent Implantation

Repeated Sirolimus-Eluting Stent Implantation to Treat Sirolimus-Eluting Stent and Bare-Metal Stent Restenosis

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