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(Circulation. 2004;109:2500-2502.)
© 2004 American Heart Association, Inc.

Brief Rapid Communications

Post–Sirolimus-Eluting Stent Restenosis Treated With Repeat Percutaneous Intervention

Late Angiographic and Clinical Outcomes

Pedro A. Lemos, MD, PhD; Carlos A.G. van Mieghem, MD; Chourmouzios A. Arampatzis, MD; Angela Hoye, MB, ChB, MRCP; Andrew T.L. Ong, MBBS, FRACP; Eugene McFadden, MB, ChB, FRCPI; Georgios Sianos, MD, PhD; Willem J. van der Giessen, MD, PhD; Pim J. de Feyter, MD, PhD; Ron T. van Domburg, PhD; Patrick W. Serruys, MD, PhD

From Erasmus Medical Center, Thoraxcenter, Rotterdam, the Netherlands.

Correspondence to Professor P.W. Serruys, MD, PhD, Thoraxcenter, Bd-406, Dr Molewaterplein 40, 3015-GD Rotterdam, The Netherlands. E-mail p.w.j.c.serruys{at}erasmusmc.nl

Received February 10, 2004; revision received April 8, 2004; accepted April 12, 2004.

Background— We evaluated the clinical and angiographic outcomes of patients presenting with restenosis after sirolimus-eluting stent (SES) implantation treated with repeated percutaneous intervention.

Methods and Results— A total of 24 consecutive patients have undergone repeated percutaneous intervention to treat post-SES restenosis (27 lesions). The restenosis was located within the stent in 93% of lesions. From the 27 lesions, 1 (4%) was re-treated with a bare stent, 3 (11%) were treated with balloon dilatation, and the remaining 23 lesions (85%) were treated with repeated drug-eluting stent implantation (SES in 12 lesions [44%], paclitaxel-eluting stents in 11 lesions [41%]). The event-free survival rate was 70.8% after a median follow-up of 279 days from the post-SES treatment. The overall recurrent restenosis rate was 42.9%. The risk of recurrent restenosis was increased for patients with hypercholesterolemia, previous angioplasty, failed brachytherapy, post-SES restenosis needing early (<6 months) treatment, and post-SES restenosis treated with balloon dilatation. The recurrent restenosis rate of originally de novo lesions re-treated with drug-eluting stents was 18.2%.

Conclusions— Even though de novo lesions treated with SES at baseline and re-treated with drug-eluting stents had reasonably better outcomes than other lesion types and strategies, our study shows that the treatment of post-SES restenosis is currently suboptimal and warrants further investigation.

Key Words: atherosclerosis • coronary disease • restenosis • stents

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