Long term clinical outcomes of brachytherapy, bare-metal stenting, and drug-eluting stenting for de novo and in-stent restenosis lesions: Five year follow-up

Background. Although drug-eluting stents (DES) have reduced the rates of in-stent restenosis (ISR) compared with bare-metal stents (BMS), DES related ISR (DES-ISR) still occurs and outcomes of DES-ISR remain unclear. The objective of this meta-analysis was to investigate the long-term clinical outcomes of patients with DES-ISR compared with patients with BMS related ISR (BMS-ISR) after the treatment of DES or drug-eluting balloon (DEB). Methods and results. We searched the literature in the main electronic databases including PUBMED, EMBASE, Cochrane Library, and Web of Science. The primary endpoints were target lesion revascularization (TLR) and target vessel revascularization (TVR). The secondary endpoints included all cause death (ACD), cardiac death (CD), myocardial infarction (MI), stent thrombosis or re-in-stent restenosis (ST/RE-ISR), and major adverse cardiovascular events (MACEs). A total of 19 studies with 6256 participants were finally included in this meta-analysis. Results showed that the rates of TLR (P<0.00001), TVR (P<0.00001), CD (P=0.02), ST/RE-ISR (P<0.00001), and MACEs (P<0.00001) were significantly higher in the DES-ISR group than in the BMS-ISR group. No significant differences were found between the two groups in the rates of MI (P=0.05) and ACD (P=0.21). Conclusions. Our study demonstrated that patients with DES-ISR had worse clinical outcomes at the long-term follow-up than patients with BMS-ISR after the treatment of DES or DEB, suggesting that DES and DEB may be more effective for BMS-ISR than that for DES-ISR. Positive prevention of DES-ISR is indispensable and further studies concentrating on detecting the predictors of outcomes of DES-ISR are required.

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Long-Term Clinical Follow-Up after Drug-Eluting Stent Implantation for Bare Metal In-Stent Restenosis

Journal of Interventional Cardiology ◽

10.1111/joic.12027 ◽

2013 ◽

Vol 26 (3) ◽

pp. 271-277

Author(s):

BALAZS BERTA ◽

ZOLTAN RUZSA ◽

GYORGY BARCZI ◽

DAVID BECKER ◽

LASZLO GELLER ◽

...

Keyword(s):

Stent Implantation ◽

Drug Eluting Stent ◽

Bare Metal ◽

Stent Restenosis ◽

Drug Eluting ◽

In Stent Restenosis

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Long-Term Follow-Up of Percutaneous Coronary Intervention With Paclitaxel-Eluting Balloon Catheter

Angiology ◽

10.1177/0003319720979246 ◽

2020 ◽

pp. 000331972097924

Author(s):

Ignacio Sanchez-Perez ◽

Jose Abellan-Huerta ◽

Alfonso Jurado-Roman ◽

Maria T. Lopez-Lluva ◽

Natalia Pinilla-Echeverri ◽

...

Keyword(s):

De Novo ◽

Long Term Results ◽

Stent Restenosis ◽

Percutaneous Coronary ◽

Long Term Follow Up ◽

Drug Eluting ◽

Coronary Lesions ◽

In Stent Restenosis

Drug-eluting balloons currently constitute a therapeutic tool used in percutaneous coronary interventions (PCI). Long-term results remain unknown. We evaluated the prognosis of PCI using a second generation paclitaxel-eluting balloon (PEB) in real-world patients. We included all PCI with PEB in de novo or in-stent restenosis coronary lesions performed in our unit from March 2009 to March 2019. We assessed the composite of major adverse cardiovascular events (MACE) rate after a median follow-up of 42 months. Consecutive patients (n = 320) with 386 lesions were included; 46.9% presented with stable angina and 53.1% acute coronary syndromes; 52.6% of the lesions were in-stent restenosis and 47.3% de novo lesions with a mean diameter of 2.4 ± 0.5 mm. A bare metal stent was implanted in 6.7% and a drug-eluting stent in 8.5% of patients. The MACE rate was 8%: 10 (2.6%) cardiovascular deaths, 13 (3.4%) myocardial infarctions, and 16 (4.1%) target lesion revascularization. The all-cause death rate was 5.2%. No cases of thrombosis were recorded. In conclusion, PEB was a safe and effective tool to treat in-stent restenosis and de novo coronary lesions, especially small vessel disease, during long-term follow-up.

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Long-term follow-up of patients with sirolimus-eluting stents for treatment of bare-metal in-stent restenosis

International Journal of Cardiology ◽

10.1016/j.ijcard.2008.11.029 ◽

2010 ◽

Vol 140 (2) ◽

pp. 219-225 ◽

Cited By ~ 3

Author(s):

Claude Le Feuvre ◽

Aude Healy-Brucker ◽

Gérard Helft ◽

Jacques Monségu ◽

Olivier Varenne ◽

...

Keyword(s):

Bare Metal ◽

Stent Restenosis ◽

Long Term Follow Up ◽

In Stent Restenosis

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Long Term Clinical Outcomes of Treatment of In-Stent Restenosis With Drug Eluting Stents

Heart Lung and Circulation ◽

10.1016/j.hlc.2009.04.011 ◽

2009 ◽

Vol 18 ◽

pp. S5

Author(s):

S Cherian ◽

C Sebastian ◽

A Puri ◽

M Liang ◽

G Devlin

Keyword(s):

Clinical Outcomes ◽

Drug Eluting Stents ◽

Stent Restenosis ◽

Drug Eluting ◽

In Stent Restenosis

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Abstract 17259: Differential Changes in Plaque Behind the Stent After Bare-Metal and Drug-Eluting Stent Implantation in Humans: Implications for In-Stent Restenosis?

Circulation ◽

10.1161/circ.130.suppl_2.17259 ◽

2014 ◽

Vol 130 (suppl_2) ◽

Author(s):

Ioannis Andreou ◽

Koki Shishido ◽

Antonios P Antoniadis ◽

Saeko Takahashi ◽

Masaya Tsuda ◽

...

Keyword(s):

Atherosclerotic Plaque ◽

Neointimal Hyperplasia ◽

Drug Eluting Stent ◽

Bare Metal ◽

Stent Restenosis ◽

Drug Eluting ◽

Relative Change ◽

The Impact ◽

In Stent Restenosis

Background: The natural history and the role of the atherosclerotic plaque located behind the stent (PBS) are still poorly understood. We evaluated the serial changes in PBS following bare-metal (BMS) compared with first-generation drug-eluting stent (DES) implantation and the impact of these changes on in-stent neointimal hyperplasia (NIH). Methods: 3D coronary reconstruction by angiography and intravascular ultrasound were serially performed after intervention and at 6- to 10-month follow-up in 157 Japanese patients treated with BMS (n=90) and DES (n=98; 68 sirolimus-eluting and 30 paclitaxel-eluting stents) included in the PREDICTION Study. Each reconstructed stented coronary artery was divided into consecutive 1.5-mm segments. External elastic lamina, lumen, stent, and PBS area were measured for each segment at both baseline and follow-up. At follow-up NIH area was assessed. Due to the very low rate of events in our population we used significant NIH (defined as NIH area >50% of stent area) as a binary anatomic outcome. Results: Patient, lesion, and stent characteristics were comparable between BMS and DES. There was a significant decrease in PBS area after BMS (median relative change: -7.2%, IQR -19.3 to 5.2%, p<0.001) and a significant increase after DES implantation (median relative change: 6.1%, IQR -5.7 to 20.5%, p<0.001). The decrease in PBS area significantly predicted NIH area at follow-up after controlling for baseline lumen area and baseline PBS area in both BMS (β 0.15, 95% CI 0.1 to 0.2, p<0.001) and DES (β 0.09, 95% CI 0.07 to 0.11, p<0.001). The decrease in PBS area was the most powerful predictor of significant NIH in both BMS (OR 1.13, 95% CI 1.02 to 1.26, p=0.017) and DES (OR 1.65, 95% CI 1.16 to 2.36, p=0.005). Conclusions: The PBS significantly decreased 6 to 10 months after BMS implantation, whereas after DES it increased. The decrease in PBS area was significantly associated with the development of NIH at follow-up in both stent types. These findings raise the possibility of a communication between the lesion within the stent and the underlying native atherosclerotic plaque, and may have important implications regarding the pathobiology of in-stent restenosis.

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Treatment of In-stent Restenosis – Past, Present and Future

European Cardiology Review ◽

10.15420/ecr.2009.5.2.74 ◽

2009 ◽

Vol 5 (2) ◽

pp. 74 ◽

Cited By ~ 2

Author(s):

Fernando Alfonso ◽

Keyword(s):

Clinical Problem ◽

Historical Background ◽

Drug Eluting Stents ◽

Bare Metal ◽

Future Perspectives ◽

Technical Challenge ◽

Stent Restenosis ◽

Drug Eluting ◽

In Stent Restenosis

In-stent restenosis (ISR) remains a significant clinical problem. The penetration of drug-eluting stents (DES) is quite variable and patients with DES may also suffer from ISR. Treatment of ISR remains a technical challenge and the long-term clinical outcome of these patients may be complicated by recurrences. Different strategies have been used for the treatment of patients with bare-metal ISR. Currently, DES constitute the intervention of choice in this setting. However, the best intervention for patients suffering from ISR after DES implantation remains to be elucidated. This report summarises our clinical and research efforts in this adverse anatomical scenario over the last decade. We will address the treatment of patients with ISR, revisiting the historical background, emphasising the currently available alternatives and disclosing future perspectives.

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