Abstract 2160: Long term Outcomes Of Paclitaxel-Eluting Stent Implantation As An Initial Treatment Strategy for Sirolimus-Eluting Stent Failure
Background: The long-term efficacy of paclitaxel-eluting stent (PES) implantation for the treatment of sirolimus-eluting stent (SES) restenosis is not known.
Methods: Patients were considered eligible for inclusion if:
initial lesion treated by the SES was de novo;
no other modality had been used to treat the SES restenosis previously; and
1 year had passed since PES implantation. A lesion length < 10 mm was defined as focal.
Results: A total of 128 consecutive patients with 147 restenotic SES lesions were treated with PES. Mean patient age was 64±12 years, diabetes was present in 40%, and the target lesion was focal in 69%. Clinical FU was complete in 100% at a median of 454 days post-procedure (range, 12 to 30 months). Death occurred in 2 patients (1.5%), one from cancer and the other from sepsis. Out-of hospital myocardial infarction occurred in 1 patient (0.8%). There were no episodes of ARC-defined stent thrombosis. The incidence of target lesion revascularization (TLR) was 23.8%. The median time to TLR was 251 days (range, 75 to 511 days) There was no difference in the rate of TLR between focal and diffuse lesions (25.5% vs 26.7%, p=ns). The only clinical or angiographic characteristics associated with TLR were a smaller post-procedure minimal luminal diameter (MLD) and greater post-procedure diameter stenosis.
Conclusions: An initial treatment strategy of PES implantation for SES restenosis is safe and provides adequate outcomes at more than 1 year follow-up. Special attention should be paid to achieving an optimal angiographic outcome, since smaller post-procedure MLD and greater residual stenosis are associated with longer-term failure. Given that TLR was not infrequent in our study, a randomized trial of PES versus stand-alone angioplasty for SES restenosis should be considered.