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Management of Restenosis after Stenting in Left Main Coronary Artery Disease

Chen-Wei Huang1, Mu-Shiang Huang1,2, Pei-Fang Su2

  • 1Division of Cardiology, Department of Internal Medicine, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University.

Acta Cardiologica Sinica
|March 13, 2023
PubMed

Insights

For left main coronary artery disease with in-stent restenosis, drug-coated balloon angioplasty and new drug-eluting stents offer similar outcomes. Both treatments are viable alternatives to bypass surgery when it is not an option.

Area of Science:

  • Interventional Cardiology
  • Cardiovascular Research
  • Medical Device Technology

Background:

  • Optimal treatment for in-stent restenosis (ISR) in left main (LM) coronary artery disease, especially as an alternative to coronary artery bypass graft surgery (CABG), is not well-defined.
  • Left main coronary artery disease poses significant risks, and managing ISR within this critical vessel requires careful consideration of treatment strategies.

Purpose of the Study:

  • To compare the clinical effectiveness of a new drug-eluting stent (new-DES) strategy versus a drug-coated balloon (DCB) only strategy for treating left main in-stent restenosis (LM-ISR).
  • To evaluate major adverse cardiovascular events (MACEs) and individual components in patients with LM-ISR unsuitable for CABG.

Main Methods:

  • Retrospective analysis of intervention reports from a database, identifying patients with LM stents and subsequent LM-ISR.
  • Patients were divided into two groups: new-DES implantation and DCB-only treatment.
  • Comparison of composite MACEs and individual endpoints, including cardiovascular death, myocardial infarction, and target lesion revascularization, with additional meta-analysis of similar studies.

Main Results:

  • No significant differences in MACEs (50.0% vs. 50.0%) were observed between the new-DES (n=40) and DCB-only (n=22) groups.
  • Individual endpoints such as cardiovascular death, nonfatal myocardial infarction, and target lesion revascularization also showed no statistically significant differences between the groups.
  • A meta-analysis of four similar studies corroborated the comparable MACE findings (odds ratio: 0.85, 95% CI: 0.44-1.67).

Conclusions:

  • Both DCB angioplasty and repeat DES implantation are effective treatment options for LM-ISR lesions in patients not suitable for CABG.
  • These interventions demonstrate comparable medium-term clinical results regarding MACEs, providing valuable insights for treatment decisions.
Abstract

Keywords:
Coronary artery bypassCoronary restenosisPercutaneous coronary intervention

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