Intracoronary brachytherapy for in-stent restenosis of drug-eluting stents

Background. In-stent restenosis (ISR) remains a common problem following percutaneous coronary intervention (PCI). However, the best treatment strategy remains uncertain. There is some controversy over the efficacy of drug-eluting balloons (DEBs) and second-generation drug-eluting stents (DESs) for treating ISR. Methods. A meta-analysis was used to compare the efficacy of the DEB and second-generation DES in the treatment of ISR. The primary endpoint is the incidence of target lesion revascularization (TLR). The secondary endpoint is the occurrence of target vessel revascularization (TVR), myocardial infarction (MI), all-cause death (ACM), cardiac death (CD), major adverse cardiac events (MACEs), minimum luminal diameter (MLD), late luminal loss (LLL), binary restenosis (BR), and percent diameter stenosis (DS%). Results. A total of 12 studies (4 randomized controlled trials and 8 observational studies) including 2020 patients with a follow-up of 6–25 months were included in the present study. There was a significant difference in the MLD between the two groups during follow-up (P=0.007, RR = 0.23, and 95% CI: 0.06–0.4 mm). There was no significant difference in LLL, BR, or DS% and the overall incidence of MACEs between the two groups. Subgroup analysis showed no significant difference in the incidence of primary and secondary endpoints when considering RCTs or observational studies only. Conclusions. The efficacy of the DEB and second-generation DES in the treatment of ISR is comparable. However, our results need further verification through multicenter randomized controlled trials.

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Predictive value of the CHA2DS2-VASc Score in detecting in-stent restenosis among patients who underwent previous revascularization due to stable angina or acute coronary syndromes

QJM ◽

10.1093/qjmed/hcaa041.013 ◽

2020 ◽

Vol 113 (Supplement_1) ◽

Author(s):

R Ayman ◽

H Shehata ◽

E AL-Fikki ◽

Y Gomaa

Keyword(s):

Significant Relationship ◽

Stable Angina ◽

Predictive Value ◽

Long Term Results ◽

Drug Eluting Stents ◽

P Value ◽

Stent Restenosis ◽

Stent Length ◽

Drug Eluting ◽

In Stent Restenosis

Abstract Background Introduction of coronary stents in the field of interventional cardiology has significantly improved short- and long-term results of the percutaneous coronary interventions but in the same time they became responsible for development of a new entity called neo-intimal hyperplasia (NIH). If overexpressed, NIH can lead to so-called in-stent restenosis (ISR). Objective To assess the predictive value of the CHA2DS2-VASc Score in detecting in-stent restenosis among patients who underwent previous revascularization in Proximal Left Anterior Descending(LAD) Artery using Drug Eluting Stents (DES) due to stable angina and acute coronary syndrome. Material and Methods This study was conducted over 113 pateints to assess the predictive value of the CHA2DS2-VASc Score in detecting in-stent restenosis among patients who underwent previous revascularization in Proximal Left Anterior Descending (LAD) Artery using Drug Eluting Stents (DES). Results From the study population collected(n = 113), 18.4% of which were females (n = 21), statistically significant relation was found between DES-ISR and CHADSVasc score (p value =0.033). A significant relationship existed between ISR and CHADVasc score 3 or more, and each of: Age(p value= 0.022), DM(p value=0.029), SBP during the procedure(p value = 0.036), time since the PCI was done(p value =0.001), stent length(p value=0.028), pattern of the lesion and management of the lesions as individual variables (p value less than0.001). However, non-significant relationship could be concluded between ISR and each of gender(p value= 0.987), CHF(p value=0.163), HTN(p value=0.446), vascular diseases (p value=0.662), CAD type (SCAD or ACS)(p value=0.616), DBP during the procedure(p value=0.167), creatinine clearance (p value=0.69), HBA1c(p value=0.091), use of DAPT(p value=0.198), the duration of DAPT use(p value=0.873), type of P2Y12 inhibitor used(p value=0.083), use of statins(p value=0.402), beta blockers or nitrates (p values= 1 & 0.836, respectively) and stent diameter used (p value=0.615) Conclusion This study was able to show a significant relationship between ISR and each of CHADVasc score, Age, DM, SBP during the procedure, time since the PCI was done, stent length used, pattern of the lesion and management of the lesions

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