Recurrent pulmonary vein stenosis after successful intervention: Prognosis and management of restenosis. Issue 5 (19th December 2019)

• Record Type: Journal Article
• Authors: Fender, Erin A.; Widmer, R. Jay; Mahowald, Madeline K; Hodge, David O.; Packer, Douglas L.; Holmes, David R.
• Is Part Of: Catheterization and cardiovascular interventions. Volume 95:Issue 5(2020)
• Page Start: 954
• Page End: 958
• Publication Date: 2019-12-19
• Subjects: pulmonary vein stenosis -- vascular patency -- stents -- balloon angioplasty -- catheter ablation; Heart -- Diseases -- Diagnosis -- Periodicals; Cardiac catheterization -- Periodicals; 616.1207572
• DOI: 10.1002/ccd.28645
• Languages: English
• ISSNs: 1522-1946

Abstract

Abstract: Objectives: The aim of this study was to describe management of recurrent pulmonary vein stenosis (PVS) and determine if stenting is superior to balloon angioplasty (BA) in preventing subsequent restenosis. Background: PVS is a serious complication of atrial fibrillation ablation. BA and stenting are effective therapies; however, restenosis frequently occurs. Here we report management of recurrent stenosis. Methods: This was a prospective observational study performed from 2000 to 2014. Results: One hundred and thirteen patients with severe PVS underwent intervention in 88 veins treated with BA and 81 treated with stenting. Forty‐two patients experienced restenosis. Restenosis was more common in veins treated with BA (RRR 53% [95% CI 32–70%, p = .008]). A second intervention was performed in 41 patients. In the 34 vessels treated with initial BA, 24 were treated for restenosis with a stent and 10 were treated with a second BA. The recurrence rate was 46% in those treated with BA followed by stenting and 50% in those treated with two BA procedures. In the 22 veins treated with initial stenting, 9 were treated with another stent and 13 were treated with BA. The recurrence rate was 44% in those treated with a second stent and 46% for those treated with a stent followed by BA. The risk of a third stenosis was the same among all groups (Analysis of variance [ANOVA] p = .99). Limited sample size precluded analysis of outcome by stent size. Conclusions: Restenosis occurred in 44% of patients overall. Management is challenging; stenting does not appear to be superior to BA.