Long-term clinical follow-up after successful repeat percutaneous intervention for stent restenosis

Columbus Clinic, Milan, Italy.

OBJECTIVES: This study evaluated the long-term clinical outcome of successful repeat percutaneous intervention after in-stent restenosis. BACKGROUND: Recurrence of symptoms and angiographic restenosis after stent implantation are observed in 15% to 35% of cases. Repeat percutaneous treatment for in-stent restenosis has been shown to be safe, with high immediate success, but little is known about the long-term clinical outcome. METHODS: Clinical follow-up (minimum 9 months) was obtained in a consecutive series of 124 patients (127 vessels) presenting with stent restenosis who were successfully treated with repeat percutaneous intervention. RESULTS: Clinical follow-up was obtained in all 124 patients at a mean [+/-SD] of 27.4 +/- 14.7 months (range 9 to 66); a stress test was available in 88 patients (71%). Recurrence of clinical events occurred in 25 patients (20%) and included death from any cause in 2 patients (2%), target vessel revascularization in 14 (11%), myocardial infarction in 1 (1%) and positive stress test results or recurrence of symptoms (Canadian Cardiovascular Society class I to IV) treated medically in 8 (6%). Cumulative event-free survival at 12 and 24 months was 86.2% and 80.7%, respectively. Significant predictive factors of recurrence of clinical events were repeat intervention in saphenous vein grafts, multivessel disease, low ejection fraction and a < or = 3-month interval between stent implantation and repeat intervention. CONCLUSIONS: In-stent balloon angioplasty for stent restenosis in native vessels seems to be an effective method in terms of a low long-term clinical event rate.

This article has been cited by other articles:

				G. W. Stone, S. G. Ellis, C. D. O'Shaughnessy, S. L. Martin, L. Satler, T. McGarry, M. A. Turco, D. J. Kereiakes, L. Kelley, J. J. Popma, et al. Paclitaxel-Eluting Stents vs Vascular Brachytherapy for In-Stent Restenosis Within Bare-Metal Stents: The TAXUS V ISR Randomized Trial JAMA, March 15, 2006; 295(11): 1253 - 1263. [Abstract] [Full Text] [PDF]

				I. Iakovou, T. Schmidt, L. Ge, G. M. Sangiorgi, G. Stankovic, F. Airoldi, A. Chieffo, M. Montorfano, M. Carlino, I. Michev, et al. Angiographic patterns of restenosis after paclitaxel-eluting stent implantation J. Am. Coll. Cardiol., March 1, 2005; 45(5): 805 - 806. [Full Text] [PDF]

				R. Albiero, S. Silber, C. Di Mario, C. Cernigliaro, S. Battaglia, B. Reimers, A. Frasheri, V. Klauss, J. M. Auge, P. Rubartelli, et al. Cutting balloon versus conventional balloon angioplasty for the treatment of in-stent restenosis: Results of the restenosis cutting balloon evaluation trial (RESCUT) J. Am. Coll. Cardiol., March 17, 2004; 43(6): 943 - 949. [Abstract] [Full Text] [PDF]

				R. Waksman, A. E. Ajani, R. L. White, R. Chan, B. Bass, A. D. Pichard, L. F. Satler, K. M. Kent, R. Torguson, R. Deible, et al. Five-Year Follow-Up After Intracoronary Gamma Radiation Therapy for In-Stent Restenosis Circulation, January 27, 2004; 109(3): 340 - 344. [Abstract] [Full Text] [PDF]

				M. Sahara, H. Kirigaya, Y. Oikawa, J. Yajima, K. Ogasawara, H. Satoh, K. Nagashima, H. Hara, Y. Nakatsu, and T. Aizawa Arterial remodeling patterns before intervention predict diffuse in-stent restenosis: An intravascular ultrasound study J. Am. Coll. Cardiol., November 19, 2003; 42(10): 1731 - 1738. [Abstract] [Full Text] [PDF]

				D. A. Cox, G. W. Stone, C. L. Grines, T. Stuckey, D. J. Cohen, J. E. Tcheng, E. Garcia, G. Guagliumi, R. S. Iwaoka, M. Fahy, et al. Outcomes of optimal or "stent-like"balloon angioplasty in acutemyocardial infarction: the CADILLAC trial J. Am. Coll. Cardiol., September 17, 2003; 42(6): 971 - 977. [Abstract] [Full Text] [PDF]

				P.W Radke, A Kaiser, C Frost, and U Sigwart Outcome after treatment of coronary in-stent restenosis: Results from a systematic review using meta-analysis techniques Eur. Heart J., February 1, 2003; 24(3): 266 - 273. [Abstract] [Full Text] [PDF]

				V. Spanos, G. Stankovic, J. Tobis, and A. Colombo The challenge of in-stent restenosis: insights from intravascular ultrasound Eur. Heart J., January 2, 2003; 24(2): 138 - 150. [Full Text] [PDF]

				J. vom Dahl, U. Dietz, P. K. Haager, S. Silber, L. Niccoli, H. J. Buettner, F. Schiele, M. Thomas, P. Commeau, D. R. Ramsdale, et al. Rotational Atherectomy Does Not Reduce Recurrent In-Stent Restenosis: Results of the Angioplasty Versus Rotational Atherectomy for Treatment of Diffuse In-Stent Restenosis Trial (ARTIST) Circulation, February 5, 2002; 105(5): 583 - 588. [Abstract] [Full Text] [PDF]

				S.-W. Park, M.-K. Hong, D. H. Moon, S. J. Oh, C. W. Lee, J.-J. Kim, and S.-J. Park Treatment of diffuse in-stent restenosis with rotational atherectomy followed by radiation therapy with a rhenium-188-mercaptoacetyltriglycine-filled balloon J. Am. Coll. Cardiol., September 1, 2001; 38(3): 631 - 637. [Abstract] [Full Text] [PDF]

				M. Adamian, A. Colombo, C. Briguori, T. Nishida, F. Marsico, C. Di Mario, R. Albiero, I. Moussa, and J. W. Moses Cutting balloon angioplasty for the treatment of in-stent restenosis: a matched comparison with rotational atherectomy, additional stent implantation and balloon angioplasty J. Am. Coll. Cardiol., September 1, 2001; 38(3): 672 - 679. [Abstract] [Full Text] [PDF]

				J. M. Ahmed, G. S. Mintz, R. Waksman, R. Mehran, B. Leiboff, A. D. Pichard, L. F. Satler, K. M. Kent, and N. J. Weissman Serial Intravascular Ultrasound Assessment of the Efficacy of Intracoronary {gamma}-Radiation Therapy for Preventing Recurrence in Very Long, Diffuse, In-Stent Restenosis Lesions Circulation, August 21, 2001; 104(8): 856 - 859. [Abstract] [Full Text] [PDF]

				S. C. Smith Jr, J. T. Dove, A. K. Jacobs, J. Ward Kennedy, D. Kereiakes, M. J. Kern, R. E. Kuntz, J. J. Popma, H. V. Schaff, D. O. Williams, et al. ACC/AHA guidelines for percutaneous coronary intervention (revision of the 1993 PTCA guidelines): A report of the American College of Cardiology/ American Heart Association Task Force on practice guidelines (Committee to revise the 1993 guidelines for percutaneous transluminal coronary angioplasty) endorsed by the Society for Cardiac Angiography and Interventions J. Am. Coll. Cardiol., June 15, 2001; 37(8): 2239 - 2239. [Full Text] [PDF]

				A. Moustapha, A. R. Assali, S. Sdringola, W. K. Vaughn, R. D. Fish, O. Rosales, G. Schroth, Z. Krajcer, R. W. Smalling, and H. V. Anderson Percutaneous and surgical interventions for in-stent restenosis: long-term outcomes and effect of diabetes mellitus J. Am. Coll. Cardiol., June 1, 2001; 37(7): 1877 - 1882. [Abstract] [Full Text] [PDF]

				F. SCHIELE The "angioplastically correct" follow up strategy after stent implantation Heart, April 1, 2001; 85(4): 363 - 364. [Full Text]

				J. M. Ahmed, G. S. Mintz, R. Waksman, N. J. Weissman, B. Leiboff, A. D. Pichard, L. F. Satler, K. M. Kent, and M. B. Leon Serial Intravascular Ultrasound Analysis of the Impact of Lesion Length on the Efficacy of Intracoronary {{gamma}}-Irradiation for Preventing Recurrent In-Stent Restenosis Circulation, January 16, 2001; 103(2): 188 - 191. [Abstract] [Full Text] [PDF]

				R. Hoffmann and G.S. Mintz Coronary in-stent restenosis--predictors, treatment and prevention Eur. Heart J., November 1, 2000; 21(21): 1739 - 1749. [PDF]

				F. Alfonso, C. Hernandez, M. J. Perez-Vizcayno, R. Hernandez, A. Fernandez-Ortiz, J. Escaned, C. Banuelos, M. Sabate, M. Sanmartin, C. Fernandez, et al. Fate of stent-related side branches after coronary intervention in patients with in-stent restenosis J. Am. Coll. Cardiol., November 1, 2000; 36(5): 1549 - 1556. [Abstract] [Full Text] [PDF]

				C Di Mario, F Marsico, M Adamian, E Karvouni, R Albiero, and A Colombo New recipes for in-stent restenosis: cut, grate, roast, or sandwich the neointima? Heart, November 1, 2000; 84(5): 471 - 475. [Full Text]

				C M Gross, J Kramer, O Weingartner, F Uhlich, R Dietz, and J Waigand Clinical and angiographic outcome in patients with in-stent restenosis and repeat target lesion revascularisation in small coronary arteries Heart, September 1, 2000; 84(3): 307 - 313. [Abstract] [Full Text] [PDF]

				R. Koster, J. Kahler, W. Terres, J. Reimers, S. Baldus, D. Hartig, J.u. Berger, T. Meinertz, and C. W. Hamm Six-month clinical and angiographic outcome after successful excimer laser angioplasty for in-stent restenosis J. Am. Coll. Cardiol., July 1, 2000; 36(1): 69 - 74. [Abstract] [Full Text] [PDF]

				F Schiele, N Meneveau, M.-F Seronde, M.-F Deforet, S Gupta, and J.-P Bassand Predictors of event-free survival after repeat intracoronary procedure for in-stent restenosis. Study with angiographic and intravascular ultrasound imaging Eur. Heart J., May 1, 2000; 21(9): 754 - 762. [Abstract] [PDF]

				I. Bossi, C. Klersy, A. J. Black, R. Cortina, R. Choussat, B. Cassagneau, C. Jordan, J.-C. Laborde, J.-P. Laurent, M. Bernies, et al. In-stent restenosis: long-term outcome and predictors of subsequent target lesion revascularization after repeat balloon angioplasty J. Am. Coll. Cardiol., May 1, 2000; 35(6): 1569 - 1576. [Abstract] [Full Text] [PDF]

				J. P. Carrozza Jr. In-stent restenosis: should an old device treat a new problem? J. Am. Coll. Cardiol., May 1, 2000; 35(6): 1577 - 1579. [Full Text] [PDF]

				R. Mehran, G. Dangas, A. S. Abizaid, G. S. Mintz, A. J. Lansky, L. F. Satler, A. D. Pichard, K. M. Kent, G. W. Stone, and M. B. Leon Angiographic Patterns of In-Stent Restenosis : Classification and Implications for Long-Term Outcome Circulation, November 2, 1999; 100(18): 1872 - 1878. [Abstract] [Full Text] [PDF]

				R. Koster, C. W. Hamm, R. Seabra-Gomes, G. Herrmann, H. Sievert, C. Macaya, E. Fleck, K. Fischer, J. J. R. M. Bonnier, J. Fajadet, et al. Laser angioplasty of restenosed coronary stents: results of a multicenter surveillance trial J. Am. Coll. Cardiol., July 1, 1999; 34(1): 25 - 32. [Abstract] [Full Text] [PDF]

				P. W. Radke, H. G. Klues, P. K. Haager, R. Hoffmann, F. Kastrau, T. Reffelmann, U. Janssens, J. vom Dahl, and P. Hanrath Mechanisms of acute lumen gain and recurrent restenosis after rotational atherectomy of diffuse in-stent restenosis: A quantitative angiographic and intravascular ultrasound study J. Am. Coll. Cardiol., July 1, 1999; 34(1): 33 - 39. [Abstract] [Full Text] [PDF]

				C. E. E. Hanekamp, J. J. Koolen, N. H. J. Pijls, H. R. Michels, and H. J. R. M. Bonnier Comparison of Quantitative Coronary Angiography, Intravascular Ultrasound, and Coronary Pressure Measurement to Assess Optimum Stent Deployment Circulation, March 2, 1999; 99(8): 1015 - 1021. [Abstract] [Full Text] [PDF]

				S. Kasaoka, J. M. Tobis, T. Akiyama, B. Reimers, C. Di Mario, N. D. Wong, and A. Colombo Angiographic and intravascular ultrasound predictors of in-stent restenosis J. Am. Coll. Cardiol., November 15, 1998; 32(6): 1630 - 1635. [Abstract] [Full Text] [PDF]

				S. K. Sharma, S. Duvvuri, G. Dangas, A. Kini, R. Vidhun, K. Venu, J. A. Ambrose, and J. D. Marmur Rotational atherectomy for in-stent restenosis: acute and long-term results of the first 100 cases J. Am. Coll. Cardiol., November 1, 1998; 32(5): 1358 - 1365. [Abstract] [Full Text] [PDF]

				H.e. Eltchaninoff, R. Koning, C. Tron, V. Gupta, and A. Cribier Balloon angioplasty for the treatment of coronary in-stent restenosis: immediate results and 6-month angiographic recurrent restenosis rate J. Am. Coll. Cardiol., October 1, 1998; 32(4): 980 - 984. [Abstract] [Full Text] [PDF]

				J. De Gregorio, Y. Kobayashi, R. Albiero, B. Reimers, C. Di Mario, L. Finci, and A. Colombo Coronary artery stenting in the elderly: short-term outcome and long-term angiographic and clinical follow-up J. Am. Coll. Cardiol., September 1, 1998; 32(3): 577 - 583. [Abstract] [Full Text] [PDF]

				A. Shiran, G. S. Mintz, R. Waksman, R. Mehran, A. Abizaid, K. M. Kent, A. D. Pichard, L. F. Satler, J. J. Popma, and M. B. Leon Early Lumen Loss After Treatment of In-Stent Restenosis : An Intravascular Ultrasound Study Circulation, July 21, 1998; 98(3): 200 - 203. [Abstract] [Full Text] [PDF]

				C. Bauters, J.-L. Banos, E. Van Belle, E. P. Mc Fadden, J.-M. Lablanche, and M. E. Bertrand Six-Month Angiographic Outcome After Successful Repeat Percutaneous Intervention for In-Stent Restenosis Circulation, February 3, 1998; 97(4): 318 - 321. [Abstract] [Full Text] [PDF]

				I. Moussa, B. Reimers, J. Moses, C. Di Mario, L. Di Francesco, M. Ferraro, and A. Colombo Long-term Angiographic and Clinical Outcome of Patients Undergoing Multivessel Coronary Stenting Circulation, December 2, 1997; 96(11): 3873 - 3879. [Abstract] [Full Text]

				PTCA Is Effective for Stent Restenosis Journal Watch Cardiology, August 18, 1997; 1997(818): 1 - 1. [Full Text]