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Angioplasty for DES in-stent restenosis lesions may yield late restenosis
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Late restenosis was more frequent among patients treated for drug-eluting stent in-stent restenosis than in those treated for bare-metal stent in-stent restenosis, according to recent findings.
The researchers assessed long-term safety and clinical and angiographic outcomes in a cohort of 468 patients undergoing treatment for in-stent restenosis lesions. The analysis included data for 550 lesions evaluated between September 2008 and December 2012. There were 114 BMS restenosis lesions and 436 DES restenosis lesions.
Planned follow-up occurred at 6 and 18 months. Six-month data were available for 488 lesions. At that time point, recurrent restenosis was reported in 13% of lesions in the BMS in-stent restenosis group and 21.1% of those in the DES group. Seven lesions (7%) required target lesion revascularization in the BMS group vs. 54 lesions (13.9%) in the DES group.
Eighteen-month angiographic data were available for 377 of 427 lesions, which the researchers noted excluded TLR lesions. The rate of late restenosis at this time point was 2.5% in the BMS in-stent restenosis group and 16.8% of those in the DES in-stent restenosis group.
DES was associated with significantly larger delayed late lumen loss, according to the results. Restenosis at 6 months was independently predicted by factors that included previous stent size of 2.5 mm or smaller, post-procedure percentage diameter stenosis and in-stent occlusion lesion. Predictors of restenosis at 18 months included DES in-stent restenosis lesions, percentage diameter stenosis at 6 months and hemodialysis.
Other findings indicated one case of target lesion thrombosis among patients with DES in-stent restenosis.
At 24 months, TLR occurred in 8.7% of BMS in-stent restenosis cases and 24.2% of DES in-stent restenosis cases (log rank P = .003). Other 24-month data indicated no significant difference between the two groups in the incidence of a composite endpoint of cardiac death, MI or target lesion thrombosis (1.9% in the BMS group vs. 3.1% in the DES group; log rank P = .8).
“Our results suggest that late restenosis occurs after [paclitaxel-coated balloon] angioplasty for DES in-stent restenosis lesions but not for BMS in-stent restenosis lesions, and [that] risk factors of recurrent restenosis after [paclitaxel-coated balloon] angioplasty for in-stent restenosis lesions vary depending on the period of time after the procedure,” the researchers wrote. – by Rob Volansky
Disclosure: The researchers report no relevant financial disclosures.
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