CLINICAL STUDIES
In-stent restenosis: long-term outcome and predictors of subsequent target lesion revascularization after repeat balloon angioplasty
Irene Bossi, MD*,
Catherine Klersy, MD ,
Alexander J. Black, MB, BS ,
Rosario Cortina, MD*,
Remi Choussat, MD*,
Bernard Cassagneau, MD*,
Christian Jordan, MD*,
Jean-Claude Laborde, MD*,
Jean-Pierre Laurent, MD*,
Monique Bernies, MD*,
Jean Fajadet, MD* and
Jean Marco, MD*
* Unité de Cardiologie Interventionelle, Clinique Pasteur, Toulouse, France
Biometry-Research Management Department, I.R.C.C.S. Policlinico S. Pavia, Italy
Department of Cardiology, The Geelong Hospital, Victoria, Australia
Manuscript received January 4, 1999;
revised manuscript received December 30, 1999,
accepted January 12, 2000.
Reprint requests and correspondence: Dr. Irene Bossi, Unité de Cardiologie Interventionelle, Clinique Pasteur, 45, Av de Lombez, Toulouse Cedex 31076, France
marco{at}interv-cardio-toul.com
OBJECTIVES
We sought to evaluate the long-term clinical outcome of patients undergoing successful balloon angioplasty for in-stent restenosis, and to determine correlates of the need for subsequent target lesion revascularization (TLR).
BACKGROUND
In-stent restenosis can be safely treated by repeat percutaneous intervention. Reported subsequent TLR rates have varied from 20% to 80% and seem related to the type of restenotic lesion.
METHODS
The study population comprised 234 patients with follow-up data who were successfully treated with repeat balloon angioplasty for in-stent restenosis in 257 lesions between May 1995 and January 1998 at our institution.
RESULTS
Clinical follow-up was available at 459 (286 to 693) days after the repeat procedure. Event-free survival was 78.5% and 74.6% at 12 and 24 months, respectively. Recurrent events occurred in 58 patients (24.8%), including 6 deaths (2.6%), 4 myocardial infarction (1.7%) and repeat target vessel revascularization in 50 patients (21.4%). Independent predictors of repeat TLR were time to in-stent restenosis <90 days (Hazard ratio 4.67, p < 0.001), minimal luminal diameter after repeat procedure (Hazard ratio 0.38, p = 0.034) and the angiographic pattern of in-stent restenosis (Hazard ratio 1.65, p = 0.036).
CONCLUSIONS
Balloon angioplasty is an effective means of treating in-stent restenosis. The long-term results are acceptable particularly for focal restenotic lesions. Further restenosis is more common in patients with early initial recurrence, more proliferative lesions and a poorer angiographic result from repeat angioplasty.
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Abbreviations and Acronyms
| | CABG | = coronary artery bypass graft | | CI | = confidence interval | | DCA | = directional coronary atherectomy | | ELCA | = excimer laser catheter ablation | | MI | = myocardial infarction | | MLD | = minimal lumen diameter | | PTCA | = percutaneous transluminal coronary angioplasty | | PTRA | = percutaneous transluminal rotational atherectomy | | RD | = reference vessel diameter | | TLR | = target lesion revascularization |
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