Contemporary Treatment of In-Stent Restenosis and the Incidence of Recurrent In-Stent Restenosis in the Era of Drug-Eluting Stents

Ajani, Andrew E.; Yan, Bryan P.; Clark, David J.; Eccleston, David; Walton, Anthony; Lew, Robert; Meehan, Adam; Brennan, Angela; Reid, Chris; Duffy, Stephen J.; On behalf of the Melbourne Interventional Group (MIG) Investigators,

doi:10.1016/j.hlc.2007.02.089

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Volume 16, Issue 4 , Pages 269-273, August 2007

Contemporary Treatment of In-Stent Restenosis and the Incidence of Recurrent In-Stent Restenosis in the Era of Drug-Eluting Stents

Andrew E. Ajani, FRACP, MD, FJFICM
- Department of Cardiology, Royal Melbourne Hospital, Melbourne, Australia
- National Health Medical Research Council, Centre of Clinical Research Excellence in Therapeutics, Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, Australia
- Corresponding author at: Department of Cardiology, Royal Melbourne Hospital, Grattan Street, Parkville 3050, Australia. Tel.: +61 3 9347 0499; fax: +61 3 9347 6760.
Bryan P. Yan, FRACP
- Department of Cardiology, Royal Melbourne Hospital, Melbourne, Australia
David J. Clark, FRACP
- Department of Cardiology, Austin Hospital, Melbourne, Australia
David Eccleston, MMed Sci, FRACP
- Department of Cardiology, Royal Melbourne Hospital, Melbourne, Australia
Anthony Walton, FRACP
- Department of Cardiology, Alfred Hospital, Melbourne, Australia
Robert Lew, FRACP, PhD
- Department of Cardiology, Frankston Hospital, Melbourne, Australia
Adam Meehan
- National Health Medical Research Council, Centre of Clinical Research Excellence in Therapeutics, Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, Australia
Angela Brennan, RN
- National Health Medical Research Council, Centre of Clinical Research Excellence in Therapeutics, Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, Australia
Chris Reid, PhD
- National Health Medical Research Council, Centre of Clinical Research Excellence in Therapeutics, Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, Australia
Stephen J. Duffy, FRACP, PhD
- Department of Cardiology, Alfred Hospital, Melbourne, Australia
On behalf of the Melbourne Interventional Group (MIG) Investigators

Received 16 January 2006; received in revised form 8 February 2007; accepted 11 February 2007.

Background

Optimal treatment of in-stent restenosis (ISR) remains uncertain in the era of drug-eluting stents (DES). This study aims to determine contemporary treatment of ISR and to assess recurrent ISR rates in the era of DES.

Methods

We examined 60 patients presenting for treatment of ISR (one lesion per patient) who were enrolled in the Melbourne Interventional Group Registry (4% of total population of 1423 patients) between April 2004 and January 2005. Twelve-month follow-up is complete for all patients.

Results

The majority of ISR treated occurred in bare metal stents [BMS (n=52, 87%)] and had a focal (<10mm) pattern of ISR (53%). In-stent restenosis of DES occurred in eight (13%) patients. The majority of ISR were treated with additional stenting with a preference for DES over BMS in almost all cases. At 12 months, one patient died of non-cardiac cause and four patients (7%) presented with recurrent ISR. The incidence of recurrent ISR in DES was 5% (n=3). No late thrombosis was reported despite only 50% of patients having ≥12 months of clopidogrel therapy.

Conclusions

Our study suggests drug-eluting stents are safe, effective and the preferred therapy for in-stent restenosis. The incidence of recurrent drug-eluting stent restenosis at 12 months is low.

Keywords: Drug-eluting stents, In-stent restenosis, Recurrent in-stent restenosis