Abstract 3249: Clinical Outcome of Patients with Coronary Restenosis After Drug Eluting Stents
Background: Coronary restenosis after drug eluting stenting (DES) is an infrequent event. The outcome in these patients is still unknown and no strategies for treatment have yet been established.
Purposes: To analyze the clinical course of patients with coronary restenosis after treatement with DES.
Methods: Between June 2002 and December 2005, 1464 patients with complex coronary lesions prone to restenosis were treated by DES in our institutions. One hundred and twenty four patients developed restenosis in 135 arteries after treatment with rapamycin (n=78) or paclitaxel (n=57) eluting stents. Eighty patients (65%) underwent intravascular ultrasound examination of the restenotic segment. Patients were treated for restenosis according to clinical presentation, vessel size and ultrasound findings. This treatment was as follows: medical treatment (n= 20), balloon dilatation (n=32), same drug-eluting stents (n=32), different drug-eluting stents (n=47) and by-pass surgery (n=4). Patients with proliferative restenotic patterns received a second DES while patients with stent constriction or underexpansion were treated with high pressure balloon dilation.
Results: Once angiographic restenosis was evidenced and treated, mean clinical follow-up was 15±8 months. During this period, 2 patients died: one from heart failure and the other from a non cardiac cause (breast cancer). One patient developed stent thrombosis 2 months after restenosis treatment. Repeat target lesion revascularization occurred in 7 patients (5.6%). The remaining 115 patients were still asymptomatic after this time follow up period. No clinical, angiographic, or technical factors influencing major cardiac events were detected at follow-up.
Conclusions: Most patients with restenosis after drug eluting stents have a favourable course and a low rate of cardiac events. An ultrasound study seems to provide useful information for an appropriate selection of treatment modality.