AS-138: Are There Differences in Clinical Outcomes after Target Lesion Revascularization for Restenosis According to the Type of Restenosed Drug-Eluting Stent? Comparisons between Sirolimus- versus Paclitaxel-Eluting Stent Restenosis

2009 ◽  
Vol 103 (9) ◽  
pp. 62B
Author(s):  
Byeung-Keuk Kim ◽  
Seung Jin Oh ◽  
Dong Woon Jeon ◽  
Joo Young Yang ◽  
Jung-Sun Kim ◽  
...  
Keyword(s):  
Clinical Outcomes ◽  
Target Lesion ◽  
Target Lesion Revascularization ◽  
Drug Eluting Stent ◽  
Stent Restenosis ◽  
Drug Eluting

scholarly journals The Predictors of Target Lesion Revascularization and Rate of In-Stent Restenosis in the Second-Generation Drug-Eluting Stent Era

2019 ◽  
Vol 2019 ◽  
pp. 1-13
Author(s):  
Chengbin Zheng ◽  
Jeehoon Kang ◽  
Kyung Woo Park ◽  
Jung-Kyu Han ◽  
Han-Mo Yang ◽  
...  
Keyword(s):  
Target Lesion ◽  
University Hospital ◽  
Target Lesion Revascularization ◽  
Drug Eluting Stent ◽  
2Nd Generation ◽  
Stent Restenosis ◽  
Significant Difference ◽  
Drug Eluting ◽  
In Stent Restenosis

Objectives. The aim of our study was to investigate the predictors of target lesion revascularization (TLR) and to compare the in-stent restenosis (ISR) progression rates of different 2nd-generation drug-eluting stents (DES). Background. The predictors of early and late TLR after 2nd-generation DES implantation have not been fully evaluated. Methods. We analyzed 944 stented lesions from 394 patients who had at least two serial follow-up angiograms, using quantitative coronary angiography (QCA) analysis. The study endpoints were TLR and the velocity of diameter stenosis (DS) progression. Results. TLR occurred in 58 lesions (6.1%) during the first angiographic follow-up period and 23 de novo lesions (2.4%) during the following second interval. Independent predictors for early TLR were diabetes mellitus (DM) (HR 2.58, 95% CI 1.29–5.15, p=0.007), previous percutaneous coronary intervention (PCI) (HR 2.41, 95% CI 1.03–5.65, p=0.043), and postprocedure DS% (HR 1.08, 95% CI 1.05–1.11, p<0.001, per 1%), while predictors of late TLR were previous PCI (HR 9.43, 95% CI 2.58-34.52, p=0.001) and serum C-reactive protein (CRP) (HR 1.60, 95% CI 1.28-2.00, p<0.001). The ISR progression velocity (by DS%) was 12.1 ±21.0%/year and 3.7 ±10.1%/year during the first and second follow-up periods, respectively, which had no significant difference (p>0.05) between the four types of DESs. Conclusions. Our data showed that predictors for TLR may be different at different time intervals. DM, pervious PCI, and postprocedure DS could predict early TLR, while previous PCI and CRP level could predict late TLR. Contemporary DESs had similar rates of ISR progression rates. Trial Registration. This study was retrospectively registered and approved by the institutional review board of Seoul National University Hospital (no. 1801–138-918).

Combining clinical and angiographic variables for estimating risk of target lesion revascularization after drug eluting stent placement

2017 ◽  
Vol 18 (3) ◽  
pp. 169-176 ◽  
Author(s):  
Joshua M. Stolker ◽  
David J. Cohen ◽  
Kevin F. Kennedy ◽  
Michael J. Pencina ◽  
Suzanne V. Arnold ◽  
...  
Keyword(s):  
Stent Placement ◽  
Target Lesion ◽  
Target Lesion Revascularization ◽  
Drug Eluting Stent ◽  
Drug Eluting

scholarly journals Impact of stent edge dissection detected by optical coherence tomography after current-generation drug-eluting stent implantation

PLoS ONE ◽  
2021 ◽  
Vol 16 (11) ◽  
pp. e0259693
Author(s):  
Hiroyuki Jinnouchi ◽  
Kenichi Sakakura ◽  
Tomonobu Yanase ◽  
Yusuke Ugata ◽  
Takunori Tsukui ◽  
...  
Keyword(s):  
Optical Coherence Tomography ◽  
Clinical Outcomes ◽  
Cardiac Death ◽  
Target Lesion ◽  
Drug Eluting Stent ◽  
Primary Study ◽  
Optical Coherence ◽  
Current Generation ◽  
Drug Eluting ◽  
Inverse Probability Weighted

Background Stent edge dissection (SED) is a well-known predictor of worse clinical outcomes. However, impact of SED after current-generation drug-eluting stent (DES) implantation remains unknown since there was no study using only current-generation DES to assess impact of SED. This study aimed to investigate a relationship between SED detected by optical coherence tomography (OCT) and clinical outcomes after current-generation DES implantation. Methods This study enrolled 175 patients receiving OCT after current-generation DES implantation. The SED group was compared with the non-SED group in terms of the primary study endpoints which was the cumulative incidence of major adverse cardiac event (MACE) composed of cardiac death, target vessel myocardial infarction (TV-MI), and clinically-driven target lesion revascularization (CD-TLR). Results Of 175 patients, SED detected by OCT was observed in 32 patients, while 143 patients did not show SED. In the crude population, the SED group showed a significantly higher incidence of CD-TLR, definite stent thrombosis, TV-MI and cardiac death relative to the non-SED group. After adjustment by an inverse probability weighted methods, the SED group showed a significantly higher incidence of MACE compared with the non-SED group (hazard ratio 3.43, 95% confidence interval 1.09–10.81, p = 0.035). Fibrocalcific or lipidic plaques, greater lumen eccentricity, and stent-oversizing were the predictors of SED. Conclusions SED detected by OCT after the current-generation DES implantation led to unfavorable outcomes. Aggressive post-dilatation around the stent edge might worse clinical outcomes due to SED, although achievement of optimal stent expansion is strongly encouraged to improve clinical outcomes.

Abstract 17459: Drug Eluting Balloon Angioplasty is a Safe Treatment Option for In-stent Restenosis: Meta-analysis of Current Evidence

Circulation ◽  
2014 ◽  
Vol 130 (suppl_2) ◽  
Author(s):  
Sainath Gaddam ◽  
Bhavi Pandya ◽  
Mustafain Meghani ◽  
Vratika Agarwal ◽  
Armaghan Soomro ◽  
...  
Keyword(s):  
Balloon Angioplasty ◽  
Target Lesion ◽  
Target Lesion Revascularization ◽  
Current Evidence ◽  
Stent Restenosis ◽  
Number Of Patients ◽  
Drug Eluting ◽  
Drug Eluting Balloon ◽  
Plain Old Balloon Angioplasty ◽  
In Stent Restenosis

Introduction: Drug eluting balloons (DEB) were recently approved by FDA for peripheral artery interventions only. For coronary in-stent restenosis (ISR), the ACC/AHA/SCAI 2011 PCI guidelines have no recommendations on role for DEB. While ESC/EACTS 2010 PCI guidelines, have level IIa recommendation for DEB for ISR after a bare metal stent. The drug delivery kinetics with DEB allows shorter duration of dual anti-platelet therapy and has a potential role in ballooning side branches of a bifurcating lesion after stenting. Aim: To compare safety and efficacy of DEB angioplasty vs. plain old balloon angioplasty (BA) or drug eluting stent (DES) for treating coronary ISR. Methods and Results: A thorough search was performed on Pubmed, Embace and Google scholar databases for randomized control trials (RCT) comparing DEB vs. BA or DES for ISR. We compared target lesion revascularization (TLR) and MACE events for these groups. We also pooled data from registries and observation studies on DEB for outcome analysis. Total number of patients with DEB’s in our study was 3465, with 693 DEB’s in 8 RCT’s. Mean follow up period was 11 months. Pooled analysis showed significant benefit for DEB compared to plain old BA, for events of target lesion revascularization (OR= 0.25, p<0.0001), and death (OR=0.31, p<0.0001). Comparing DEB to DES, there was no statistical difference in outcomes comparing TLR (OR=1.4, p=0.14), MI or death (OR=0.65, p=0.39). Cumulative incidence of target lesion revascularization (TLR) with DEB was 6.7%. Conclusions: For coronary ISR, drug eluting balloon angioplasty is superior to plain old balloon angioplasty in terms of safety and outcomes. However, comparing drug eluting balloons vs. drug eluting stents in ISR, the outcomes are comparable and will need larger studies powered to make definitive recommendation.

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