Abstract 3253: Repeat Drug-Eluting Stent Implantation For Drug-Eluting Stent Restenosis: The Same or a Different Stent
Introduction: With the widespread penetration of drug-eluting stents (DES), the problem of restenosis is likely to become a significant one. Currently little data is available on the optimal management of DES restenosis. While there are many possible mechanical or lesion-based etiologies for DES restenosis, drug resistance may play a role.
Hypothesis: We assessed the hypothesis that implantation of a different DES would be superior to implantation of the same DES for the treatment of DES restenosis.
Methods: We identified all patients undergoing repeat DES implantation for DES restenosis in our institutions. The patients were divided into 2 groups: those receiving the same DES as the one that restenosed and those treated with the alternative DES. The endpoints analyzed were target lesion revascularization (TLR) and angiographic restenosis.
Results: We included a total of 174 patients (201 lesions) treated between October 2002 and June 2005. The same DES was implanted in 107 lesions and a different DES in 94 lesions. The rate of peri-procedural myocardial infarction (MI) was 2.7%, post discharge there were 3 deaths and 1 MI. Angiographic follow-up of the re-treatment was available in 65.2% of the lesions. Angiographic restenosis occurred in 24.3% (17) of cases treated with the same DES and 24.6% (15) of those treated with a different DES (p=1.0). TLR occurred in 15% (16) and 14.9% (7) of lesions, respectively (p=1.0). A multivariate analysis confirmed the lack of association between the treatment selected and TLR, (OR 0.704 [95% confidence intervals: 0.285–1.739]; p=0.45). A non-focal pattern of restenosis remained significantly associated with both TLR and restenosis (OR 2.981 [95% confidence intervals: 1.195–7.433], p=0.019, and OR 3.798 [95% confidence intervals: 1.525–9.458], p=0.004, respectively).
Conclusions: Repeat DES implantation for DES restenosis is feasible and safe. The rate of TLR is acceptable, with no demonstrable differences between implantation of the same or a different DES. The pattern of restenosis treated is the most important predictor of outcomes.