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

Abstract

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.

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 Impact of Angiographic Restenosis After Bare-Metal Stent Implantation on Long-Term Outcomes in Patients With Coronary Artery Disease

“…After the introduction of DES with remarkable efficacy for restenosis, DES has become the treatment of choice for BMS restenosis patients. 25, 26 In most of the present study period, however, DES was not available in Japan. Therefore, POBA, especially cutting balloon, was widely used for BMS restenosis, which resulted in a relatively higher TLR rate.…”

Drug‐Eluting Stents vs Intracoronary Brachytherapy for In‐Stent Restenosis: A Meta‐Analysis

“…In the past, the studies comparing DES to ICBT for the treatment of ISR have paid more attention to BMS restenosis, but less to DES restenosis. A recent published paper showed that the incidences of late restenosis, ischemia‐driven TLR, and MACE are higher after repeated SES implantation in ISR lesions treated with SES than in those treated with BMS 30. Therefore, ICBT remains a proven method of restenosis prevention for the treatment of ISR, and its role in treating DES restenosis remains to be studied.…”