Prognosis and Management of Recurrent Stenosis After Pulmonary Vein Stenting: A Prospective Study

Pulmonary vein stenting is effective for severe pulmonary vein stenosis, which is limited by restenosis. The assessment and management of in-stent restenosis (ISR) are inadequate, and follow-up outcomes after reintervention remain unknown.

This study aimed to assess the prognosis and management of pulmonary vein ISR and determine whether the modified stent-in-stent strategy is superior to balloon angioplasty (BA) in treating ISR.

The authors conducted a prospective observational study on patients with severe pulmonary vein stenosis post radiofrequency ablation for atrial fibrillation.

A total of 107 patients with 174 severely stenosed veins underwent successful stenting. Forty-three veins among 36 patients experienced ISR (24.7%, 43 of 174). Veins developing ISR had smaller diameter stents (7.8 ± 0.8 mm vs 9.2 ± 0.7 mm; P = 0.008). Restenosis veins were assigned to BA group or stent-in-stent group. Success rate was 95.7% for BA and 90.0% for stent-in-stent. Twelve veins experienced recurrent ISR, including 2 in stent-in-stent group (11.1%, 2 of 18) and 10 in BA group (45.5%, 10 of 22). The risk of recurrent stenosis was significantly lower in veins treated with the stent-in-stent method than with BA (HR: 0.21; 95% CI: 0.07-0.64; P = 0.02). Patients in the stent-in-stent group had greater exercise endurance and better World Health Organization cardiac functional class compared with BA group (F = 7.2; P < 0.05; and F = 4.4; P < 0.05, respectively) at 6- and 12-month follow-ups.

Our modified stent-in-stent implantation approach is superior to BA for treating pulmonary vein ISR, by reducing recurrent restenosis rate and improving exercise endurance.