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Six-month angiographic outcome after successful repeat percutaneous intervention for in-stent restenosis
C Bauters1, J L Banos, E Van Belle
1Service de Cardiologie B, Hôpital Cardiologique, Lille, France.
Insights
Repeat angioplasty for in-stent restenosis shows a low restenosis rate. However, diffuse or severe in-stent restenosis cases face higher risks, suggesting alternative treatments may be beneficial.
Area of Science:
- Cardiovascular Interventions
- Interventional Cardiology
- Vascular Medicine
Background:
- In-stent restenosis presents a growing clinical challenge.
- Published data on recurrent restenosis risk after repeat angioplasty for in-stent restenosis are inconsistent.
Purpose of the Study:
- To evaluate the outcomes of repeat percutaneous intervention for in-stent restenosis.
- To identify predictors of recurrent restenosis after repeat intervention.
Main Methods:
- Prospective angiographic follow-up of 103 patients (107 vessels) undergoing repeat percutaneous intervention for in-stent restenosis.
- Quantitative angiography used to assess restenosis (>50% diameter stenosis) at 6 months.
- Analysis of factors associated with recurrent restenosis.
Main Results:
- Primary success rate of repeat intervention was 98%.
- Overall 6-month restenosis rate was 22%; target-lesion revascularization rate was 17%.
- Diffuse in-stent restenosis and severe pre-intervention stenosis were linked to significantly higher recurrent restenosis rates.
Conclusions:
- Repeat intervention for in-stent restenosis generally yields a low restenosis rate.
- Patients with diffuse and/or severe in-stent restenosis are at increased risk.
- These high-risk patients might benefit from alternative therapeutic strategies.
Background:
In-stent restenosis is an increasing clinical problem. Discordant results have been published regarding the risk of recurrent restenosis after repeat angioplasty for the treatment of in-stent restenosis.
Methods And Results:
One hundred three consecutive patients (107 vessels) underwent repeat percutaneous intervention for the treatment of in-stent restenosis and were entered in a prospective angiographic follow-up program. Repeat balloon angioplasty was performed at 93 lesions (87%) and additional stenting at 14 lesions (13%). The primary success rate was 98%. Six-month angiographic follow-up was performed in 85% of eligible patients. Restenosis was determined by quantitative angiography. Restenosis defined as a >50% diameter stenosis at follow-up was observed at 22% of lesions. The rate of target-lesion revascularization at 6 months was 17%. Repeat intervention for diffuse in-stent restenosis and severe stenosis before repeat intervention were associated with significantly higher rates of recurrent restenosis.
Conclusions:
The overall restenosis rate after repeat intervention for in-stent restenosis is low. The subgroup of patients with diffuse and/or severe in-stent restenosis, however, is at higher risk of recurrent restenosis and may benefit from alternative therapeutic strategies.