Abstract 16723: “Resistant” In-Stent Restenosis in the Drug-Eluting Stent Era: An Angiographic Description and Outcomes
Background: In the drug eluting stent era, in-stent restenosis (ISR) followed by ISR recurrence, represents a rare yet challenging clinical problem. The definition and angiographic patterns of this phenomenon have not yet been reported.
Methods: We defined “resistant” DES ISR (R-ISR) as the second occurrence of ISR after initial successful treatment with DES. We identified 213 lesions in 201 patients treated with DES who presented with R-ISR between 2003 and 2011 at our institution. We reviewed all angiograms to assess any patterns borne from either the first and second ISR episode as described by the Mehran classification.
Results: Patients with “resistant” ISR were more frequently male (72%) with a mean age of 63 years. They presented with a very high frequency of diabetes (56%), overweight (70%), and chronic kidney disease (35%). Most lesions were bifurcation (55%) with moderate to severe calcification (58%). R-ISR presented after 34 months from the first procedure, with a focal pattern (≤10 mm in length) in 78%, and diffuse pattern (>10 mm in length) in 22% of the patients. The rates of all-cause mortality, MI, or target vessel failure (TVF) at 1-year were 4%, 3%, and 18%, respectively. Patients with paclitaxel-eluting stent (PES) R-ISR showed a higher rate of ischemic events compared with other type of stents at 1-year follow-up (table 1.).
Conclusion: Patients with “resistant” DES ISR comprise a very high-risk population with suboptimal outcomes that are characterized by a high rate of ischemic adverse events. R-ISR after PES appears to result in worse outcomes compared with other DES.
- © 2013 by American Heart Association, Inc.