Stenting the stent: Alternative strategy for treating in‐stent restenosis

Abstract

Several approaches have been taken to relieve restenosis inside a vascular stent. In a patient with a complicated history of coronary artery disease, a restenotic lesion inside a Gianturco-Roubin flex stent was relleved by angloplasty and deployment of three 10 mm Palmaz P-104 "biliary" stents, with uroklnase and verapamil used to prevent thromboembollsm and the no-refiow phenomenon. An angiographic study 6 months later showed a patent graft with no residual stenosis.

Implante de stent dentro de stent recém-implantado em ponte de veia safena para otimização do resultado angiográfico

“…Ceceña 6 tratou uma reestenose de stent GR implanta- Fig. 1 -A) PVS-CD com obstrução crítica no terço proximal e de grau moderado no terço distal (setas); B) resultado angiográfico após dilatação com balão da obstrução do terço proximal (seta); C) implante de stent GRII (seta); D) resultado após implante de stent GRII mostrando lesão residual intra-stent (seta).…”

“…Neste caso, apesar de não termos empregado ultra-som, a expansão completa dos stents foi confirmada por ACQ e, indiretamente, evidenciada pela fácil ultrapassagem de outro stent PS para implante em lesão distal no corpo da PVS-CD. A evolução a longo prazo, baseada nos casos previamente relatados [4][5][6] , provavelmente será satisfatória.…”

Limitations of coronary angiography compared with intravascular ultrasound: Implications for coronary interventions☆

“…However, they have limited power to reduce rerestenosis so that optimal strategies need to be defined. Additional stents might be effective, [296][297][298][299][300][301] especially in combination with the use of antiproliferative strategies such as radiation therapy. 302 Additional stents should be used to cover important dissections occurring in the therapy of in-stent restenosis 303 and also may be effective in reducing the problem of ''instant'' restenosis, 304 ie, recoil of fibrous tissue through the stent struts back into the lumen.…”

Pullback atherectomy for the treatment of intrastent restenosis

“…We read with interest the case report of Felipe A. Cecena that refers to stenting the stent as an alternate strategy for treating intrastent restenosis [1]. Recently, we encountered a patient who had a similar problem, which was managed differently with pullback atherectomy (PAC).…”

“…Balloon angioplasty has been considered the standard therapy; however, it is still associated with a high restenosis rate [3]. As a result, investigators have evaluated alternate treatment methods, including stenting the stent [1] and prior debulking with devices such as directional atherectomy (DCA) [4], rotational atherectomy [5], extraction atherectomy [6], and laser photoablation [7], followed by adjunctive balloon angioplasty. In addition, inhibition of intimal hyperplasia is under active investigation and remains the new challenge [7].…”