Choice of stent and outcomes after treatment of drug‐eluting stent restenosis in highly complex lesions1. Issue 1 (17th April 2012)

• Record Type: Journal Article
• Authors: Freixa, Xavier; Almasood, Ali S.; Khan, Sohail Q.; Mackie, Karen; Osten, Mark; Ing, Douglas; Overgaard, Christopher B.; Horlick, Eric M.; Seidelin, Peter H.; Džavík, Vladimír
• Is Part Of: Catheterization and cardiovascular interventions. Volume 81:Issue 1(2013:Jan. 01)
• Page Start: E16
• Page End: E22
• Publication Date: 2012-04-17
• Subjects: Heart -- Diseases -- Diagnosis -- Periodicals; Cardiac catheterization -- Periodicals; 616.1207572
• DOI: 10.1002/ccd.24291
• Languages: English
• ISSNs: 1522-1946

Abstract

<abstract abstract-type="main" xml:lang="en"> <title>Abstract</title> <sec id="abs1-1" sec-type="section"> <title>Objectives</title> <p>Our aim was to compare the outcomes of a same versus different drug‐eluting stent (DES) implantation strategy for the treatment of DES instent restenosis (ISR).</p> </sec> <sec id="abs1-2" sec-type="section"> <title>Background</title> <p>The absence of clear data renders the treatment of DES ISR one of the most challenging situations in interventional cardiology.</p> </sec> <sec id="abs1-3" sec-type="section"> <title>Methods</title> <p>We identified all cases of DES ISR treated with a second DES between January 2004 and January 2009. The lesions were divided into those treated with the same DES as the initial one that restenosed and those treated with a different DES. The main end‐point was repeat target lesion revascularization (TLR).</p> </sec> <sec id="abs1-4" sec-type="section"> <title>Results</title> <p>We included 116 patients with a total of 132 lesions. The patient population was highly complex: 55.5% with diabetes, 56% with type‐C lesions, 15.9% with lesions previously stented with BMS and 18.2% with fluoroscopic evidence of stent fracture. A same and different stent strategy was conducted in 41 lesions (31%) and 91 lesions (69%), respectively. Overall TLR was 31.1% and occurred in 46.3% of patients treated with the same stent and 24.4% of those with a different stent (<italic>P</italic> = 0.012). Multivariable analysis found same stent strategy (OR 2.84, 95%CI 1.23–6.57;<italic>P</italic> = 0.014) and occurrence of stent fracture (OR 4.03, 95%CI 1.33–12.01;<italic>P</italic> = 0.012) to be the only independent predictors of TLR after a median follow‐up of 20.4 [12.1–30.2] months.</p> </sec> <sec id="abs1-5" sec-type="section"> <title>Conclusions</title> <p>In highly complex lesions, DES implantation for DES ISR is linked to a high need of future revascularization. An association between implanting a DES type other than the original and lower rate of TLR is suggested. © 2012 Wiley Periodicals, Inc.</p> </sec> </abstract>