Limits...
Switching types of drug-eluting stents does not prevent repeated in-stent restenosis in patients with coronary drug-eluting stent restenosis.

Nojima Y, Yasuoka Y, Kume K, Adachi H, Hattori S, Matsutera R, Kohama Y, Sasaki T - Coron. Artery Dis. (2014)

Bottom Line: In patients with de-novo coronary lesions, DES implantation is associated with a markedly reduced restenosis rate as compared with that associated with a bare metal stent and POBA.Treatment with a different type or generation of DES does not appear to reduce the incidence of TLR.Moreover, we identified certain useful factors for facilitating appropriate and early triage in the patients with repeated DES ISR.

View Article: PubMed Central - PubMed

Affiliation: Department of Cardiovascular Medicine, Osaka Minami Medical Center, Osaka, Japan.

ABSTRACT

Objectives: We treated patients experiencing drug-eluting stent (DES) restenosis with plain old balloon angioplasty (POBA), implantation of the same type of DES [homogeneous drug-eluting stent (HOMO-DES)], or implantation of a different type of DES [heterogeneous drug-eluting stent (HETERO-DES)], and compared the efficacy and safety of these procedures for the prevention of repeated in-stent restenosis (ISR).

Background: In patients with de-novo coronary lesions, DES implantation is associated with a markedly reduced restenosis rate as compared with that associated with a bare metal stent and POBA. However, the optimal management strategy for patients with DES ISR remains unknown.

Patients and methods: We identified 191 consecutive DES ISR lesions from 183 patients who required clinically driven revascularization and divided them into three groups according to the treatment: 38 lesions were treated with POBA, 38 with HOMO-DES, and 115 with HETERO-DES.

Results: The incidence of target lesion revascularization (TLR) was 42.1% (16/38), 15.8% (6/38), and 16.5% (19/115) in the POBA, HOMO-DES, and HETERO-DES groups (POBA vs. HOMO, HETERO-DES; P=0.002, respectively). Multivariate analysis indicated that diabetes [odds ratio (OR), 3.4], hemodialysis (OR, 7.74), nonfocal ISR patterns (OR, 3.35), previous myocardial infarction (OR, 3.26), and POBA (OR, 8.84) were independent predictors of TLR.

Conclusion: A strategy involving repeated DES implantation was superior to POBA for preventing recurrent restenosis. Treatment with a different type or generation of DES does not appear to reduce the incidence of TLR. Moreover, we identified certain useful factors for facilitating appropriate and early triage in the patients with repeated DES ISR.

No MeSH data available.


Related in: MedlinePlus

The predominant target lesion revascularization (TLR) pattern, according to Mehran’s classification, was focal (Type I) and this pattern is associated with a lower incidence of TLR. P<0.001.
© Copyright Policy
Related In: Results  -  Collection

License
getmorefigures.php?uid=PMC4222797&req=5

Figure 1: The predominant target lesion revascularization (TLR) pattern, according to Mehran’s classification, was focal (Type I) and this pattern is associated with a lower incidence of TLR. P<0.001.

Mentions: The incidence of TLR was 42.1% (16/38), 15.8% (6/38), and 16.5% (19/115) in the POBA, HOMO-DES, and HETERO-DES groups (POBA vs. HOMO, HETERO-DES; P=0.002, respectively). However, there were no significant differences between the HOMO and the HETERO groups. The incidence of TLR classified according to the pattern of DES ISR before PCI is also shown (Fig. 1). The TLR rate was 17% (20/121) in Type I lesions, 44% (12/27) in Type II lesions, 60% (6/10) in Type III lesions, and 50% (3/6) in Type IV lesions. On the basis of the group types, the TLR rate was 17% (20/121) in the focal group and 49% (21/43) in the nonfocal group (P<0.001).


Switching types of drug-eluting stents does not prevent repeated in-stent restenosis in patients with coronary drug-eluting stent restenosis.

Nojima Y, Yasuoka Y, Kume K, Adachi H, Hattori S, Matsutera R, Kohama Y, Sasaki T - Coron. Artery Dis. (2014)

The predominant target lesion revascularization (TLR) pattern, according to Mehran’s classification, was focal (Type I) and this pattern is associated with a lower incidence of TLR. P<0.001.
© Copyright Policy
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC4222797&req=5

Figure 1: The predominant target lesion revascularization (TLR) pattern, according to Mehran’s classification, was focal (Type I) and this pattern is associated with a lower incidence of TLR. P<0.001.
Mentions: The incidence of TLR was 42.1% (16/38), 15.8% (6/38), and 16.5% (19/115) in the POBA, HOMO-DES, and HETERO-DES groups (POBA vs. HOMO, HETERO-DES; P=0.002, respectively). However, there were no significant differences between the HOMO and the HETERO groups. The incidence of TLR classified according to the pattern of DES ISR before PCI is also shown (Fig. 1). The TLR rate was 17% (20/121) in Type I lesions, 44% (12/27) in Type II lesions, 60% (6/10) in Type III lesions, and 50% (3/6) in Type IV lesions. On the basis of the group types, the TLR rate was 17% (20/121) in the focal group and 49% (21/43) in the nonfocal group (P<0.001).

Bottom Line: In patients with de-novo coronary lesions, DES implantation is associated with a markedly reduced restenosis rate as compared with that associated with a bare metal stent and POBA.Treatment with a different type or generation of DES does not appear to reduce the incidence of TLR.Moreover, we identified certain useful factors for facilitating appropriate and early triage in the patients with repeated DES ISR.

View Article: PubMed Central - PubMed

Affiliation: Department of Cardiovascular Medicine, Osaka Minami Medical Center, Osaka, Japan.

ABSTRACT

Objectives: We treated patients experiencing drug-eluting stent (DES) restenosis with plain old balloon angioplasty (POBA), implantation of the same type of DES [homogeneous drug-eluting stent (HOMO-DES)], or implantation of a different type of DES [heterogeneous drug-eluting stent (HETERO-DES)], and compared the efficacy and safety of these procedures for the prevention of repeated in-stent restenosis (ISR).

Background: In patients with de-novo coronary lesions, DES implantation is associated with a markedly reduced restenosis rate as compared with that associated with a bare metal stent and POBA. However, the optimal management strategy for patients with DES ISR remains unknown.

Patients and methods: We identified 191 consecutive DES ISR lesions from 183 patients who required clinically driven revascularization and divided them into three groups according to the treatment: 38 lesions were treated with POBA, 38 with HOMO-DES, and 115 with HETERO-DES.

Results: The incidence of target lesion revascularization (TLR) was 42.1% (16/38), 15.8% (6/38), and 16.5% (19/115) in the POBA, HOMO-DES, and HETERO-DES groups (POBA vs. HOMO, HETERO-DES; P=0.002, respectively). Multivariate analysis indicated that diabetes [odds ratio (OR), 3.4], hemodialysis (OR, 7.74), nonfocal ISR patterns (OR, 3.35), previous myocardial infarction (OR, 3.26), and POBA (OR, 8.84) were independent predictors of TLR.

Conclusion: A strategy involving repeated DES implantation was superior to POBA for preventing recurrent restenosis. Treatment with a different type or generation of DES does not appear to reduce the incidence of TLR. Moreover, we identified certain useful factors for facilitating appropriate and early triage in the patients with repeated DES ISR.

No MeSH data available.


Related in: MedlinePlus