Share This Article:

Incidence, Predictors, Treatment, and Long-Term Prognosis of Patients with Restenosis after Long Drug-Eluting Stent Implantation for Coronary Arteries

Abstract Full-Text HTML XML Download Download as PDF (Size:3486KB) PP. 631-641
DOI: 10.4236/wjcd.2014.413075    3,274 Downloads   3,766 Views  
Author(s)    Leave a comment

ABSTRACT

Background: Few data on the clinical course and management of patients experiencing restenosis after implantation of long drug-eluting stents treatment for coronary arteries was available. Objectives: The aim of this study was to evaluate the incidence, predictors, and long-term outcomes of patients with in-stent restenosis (ISR) after percutaneous coronary intervention (PCI) with long (33 mm & 38 mm) drug-eluting stents (DES) for long lesions in coronary arteries including left anterior descending artery (LAD), Lt circumflex artery (Lt Cx), right coronary artery (RCA), obtuse marginal artery (OM) & posterior descending artery (PDA). Methods: Between July 2009 and October 2010, 421 long DES had being implanted in 421 consecutive patients with significant coronary artery stenosis, with 371 patients (88%) undergoing routine follow up, clinical follow up done by exercise stress test at 6 & 12 months after stenting for 126 patients (34%), in 124 patients (33.5%) follow up was done by Computed Tomography angiography & 121 patients (32.5%) with clinically driven angiographic follow-up. A major adverse cardiac event was defined as the composite of death, myocardial infarction (MI), or target-lesion revascularization (TLR) within 15 months. Results: All patients who underwent clinical follow up were asymptomatic. The overall incidence of angiographic (CT or conventional) ISR with long (33 mm & 38 mm) DES was 4% (15 out of 371 stents) with 8 (53.3%) focal-type and 7 (46.7%) with diffuse-type ISR. Six patients (40%) under-went repeated PCI, seven (46.7%) underwent bypass surgery, and 2 (13.3%) were treated medically. During long-term follow-up (ranging from 12 - 26 months), there were no deaths, 3 (0.8%) MI, and 13 (3.5%) repeated target-lesion revascularization (PCI or CABG) cases. The incidence of major adverse cardiac event was 5.3% in the medical group, 10.1% in the repeated PCI group, and 21.4% in the bypass surgery group. Multivariate analysis showed that the occurrence of DES-ISR did not affect the risk of death or MI. Conclusions: The incidence of ISR was 4% after long DES stenting for coronary arteries. The long-term clinical prognosis of patients with long DES-ISR associated with coronary artery stenting might be benign, if the patient has optimal treatment.

Conflicts of Interest

The authors declare no conflicts of interest.

Cite this paper

Mirza, A. (2014) Incidence, Predictors, Treatment, and Long-Term Prognosis of Patients with Restenosis after Long Drug-Eluting Stent Implantation for Coronary Arteries. World Journal of Cardiovascular Diseases, 4, 631-641. doi: 10.4236/wjcd.2014.413075.

References

[1] Gruntzig, A.R., Senning, A. and Siegenthaler, W.E. (1979) Nonoperative Dilatation of Coronary Artery Stenosis: Percutaneous Transluminal Coronary Angioplasty. The New England Journal of Medicine, 301, 61-68.
http://dx.doi.org/10.1056/NEJM197907123010201
[2] Dangas, G. and Fuster, V. (1996) Management of Restenosis after Coronary Intervention. American Heart Journal, 132, 428-436.
http://dx.doi.org/10.1016/S0002-8703(96)90442-1
[3] Schatz, R.A., Palmaz, J.C., Tio, F., Garcia, F., Garcia, O. and Reuter, S.R. (1987) Balloon Expandable Intracoronary Stents in the Adult Dog. Circulation, 76, 450-457.
http://dx.doi.org/10.1161/01.CIR.76.2.450
[4] Hoffman, R., Mintz, G.S., Dussaillant, G.R., et al. (1996) Patterns and Mechanisms of Instent Restenosis: A Serial Intravascular Ultrasound Study. Circulation, 94, 1247-1254.
http://dx.doi.org/10.1161/01.CIR.94.6.1247
[5] Dussaillant, G.R., Mintz, G.S., Pichard, A., et al. (1995) Small Stent Size and Intimal Hyperplasia Contribute to Restenosis: A Volumetric Intravascular Ultrasound Analysis. Journal of the American College of Cardiology, 26, 720-724.
http://dx.doi.org/10.1016/0735-1097(95)00249-4
[6] Gordon, P.C., Gibson, M., Cohen, D.J., Carroza, J.P., Kuntz, R.E. and Baim, D.S. (1993) Mechanisms of Restenosis and Redilation within Coronary Stents—Quantitative Angiographic Assessment. Journal of the American College of Cardiology, 21, 1166-1174.
http://dx.doi.org/10.1016/0735-1097(93)90241-R
[7] Mehran, R., Dangas, G., Abizaid, A., et al. (1999) Angiographic Patterns of In-Stent Restenosis: Classification and Implications for Long-Term Outcome. Circulation, 100, 1872-1878.
http://dx.doi.org/10.1161/01.CIR.100.18.1872
[8] Goldberg, S.L., Loussararian, A., De Gregorio, J., Di Mario, C., Albiero, R. and Colombo, A. (2001) Predictors of Diffuse and Aggressive Intrastent Restenosis. Journal of the American College of Cardiology, 37, 1019-1025.
http://dx.doi.org/10.1016/S0735-1097(01)01107-X
[9] Cutlip, D.E., Windecker, S., Mehran, R., et al. (2007) Clinical End Points in Coronary Stent Trials: A Case for Standardized Definitions. Circulation, 115, 2344-2351.
http://dx.doi.org/10.1161/CIRCULATIONAHA.106.685313
[10] Costa, M.A. and Simon, D.I. (2005) Molecular Basis of Restenosis and Drug-Eluting Stents. Circulation, 111, 2257-2273.
http://dx.doi.org/10.1161/01.CIR.0000163587.36485.A7
[11] Garg, S. and Serruys, P.W. (2010) Coronary Stents: Current Status. Journal of the American College of Cardiology, 56, S1-S42.
http://dx.doi.org/10.1016/j.jacc.2010.06.007
[12] Moses, J.W., Leon, M.B., Popma, J.J., Fitzgerald, P.J., Holmes, D.R., O’Shaughnessy, C., Caputo, R.P., Kereiakes, D.J., Williams, D.O., Teirstein, P.S., Jaeger, J.L. and Kuntz, R.E. (2003) Sirolimus-Eluting Stents versus Standard Stents in Patients with Stenosis in a Native Coronary Artery. New England Journal of Medicine, 349, 1315-1323.
http://dx.doi.org/10.1056/NEJMoa035071
[13] Colombo, A., Drzewiecki, J., Banning, A., Grube, E., Hauptmann, K., Silber, S., Dudek, D., Fort, S., Schiele, F., Zmudka, K., Guagliumi, G. and Russell, M.E. (2003) Randomized Study to Assess the Effectiveness of Slow- and Moderate-Release Polymer-Based Paclitaxel-Eluting Stents for Coronary Artery Lesions. Circulation, 108, 788-794.
http://dx.doi.org/10.1161/01.CIR.0000086926.62288.A6
[14] Finn, A.V., Palacios, I.F., Kastrati, A. and Gold, H.K. (2005) Drug-Eluting Stents for Diabetes Mellitus: A Rush to Judgment? Journal of the American College of Cardiology, 45, 479-483.
http://dx.doi.org/10.1016/j.jacc.2004.10.060
[15] Rathore, S., Kinoshita, Y., Terashima, M., Katoh, O., Matsuo, H., Tanaka, N., Kimura, M., Tsuchikane, E., Nasu, K., Ehara, M., Asakura, K., Asakura, Y. and Suzuki, T. (2010) A Comparison of Clinical Presentations, Angiographic Patterns and Outcomes of In-Stent Restenosis between Bare Metal Stents and Drug Eluting Stents. EuroIntervention, 5, 841-846.
http://dx.doi.org/10.4244/EIJV5I7A141
[16] Steinberg, D.H., Pinto Slottow, T.L., Buch, A.N., Javaid, A., Roy, P.K., Garg, S., Okabe, T., Torguson, R., Smith, K.A., Xue, Z., Suddath, W.O., Kent, K.M., Satler, L.F., Pichard, A.D., Lindsay, J. and Waksman, R. (2007) Impact of In-Stent Restenosis on Death and Myocardial Infarction. American Journal of Cardiology, 100, 1109-1113.
http://dx.doi.org/10.1016/j.amjcard.2007.05.033
[17] Laskey, W., Yancy, C. and Maisel, W. (2007) Thrombosis in Coronary Drug-Eluting Stents: Report from the Meeting of the Circulatory System Medical Devices Advisory Panel of the Food and Drug Administration Center for Devices and Radiologic Health, December 7-8, 2006. Circulation, 115, 2352-2357.
http://dx.doi.org/10.1161/CIRCULATIONAHA.107.688416
[18] Abdulla, J., Abildstrom, S.Z., Gotzsche, O., Christensen, E., Kober, L. and Torp-Pedersen, C. (2007) 64-Multislice Detector Computed Tomography Coronary Angiography as Potential Alternative to Conventional Coronary Angiography: A Systematic Review and Meta-Analysis. European Heart Journal, 28, 3042-3050.
http://dx.doi.org/10.1093/eurheartj/ehm466
[19] Garcia, M.J., Lessick, J. and Hoffmann, M.H. (2006) Accuracy of 16-Row Multidetector Computed Tomography for the Assessment of Coronary Artery Stenosis. JAMA, 296, 403-411.
http://dx.doi.org/10.1001/jama.296.4.403
[20] Budoff, M.J., Dowe, D., Jollis, J.G., Gitter, M., Sutherland, J., Halamert, E., et al. (2008) Diagnostic Performance of 64 Multidetector Row Coronary Computed Tomographic Angiography for Evaluation of Coronary Artery Stenosis in Individuals without Known Coronary Artery Disease: Results from the Prospective Multicenter ACCURACY (Assessment by Coronary Computed Tomographic Angiography of Individuals Undergoing Invasive Coronary Angiography) Trial. Journal of the American College of Cardiology, 52, 1724-1732.
http://dx.doi.org/10.1016/j.jacc.2008.07.031
[21] Hoffmann, R., Mintz, G.S., Mehran, R., Pichard, A.D., Kent, K.M., Satler, L.F., Popma, J.J., Wu, H.S. and Leon, M.B. (1998) Intravascular Ultrasound Predictors of Angiographic Restenosis in Lesions Treated with Palmaz-Schatz Stents. Journal of the American College of Cardiology, 31, 43-49.
http://dx.doi.org/10.1016/S0735-1097(97)00438-5
[22] Kastrati, A., Schomig, A., Elezi, S., Schühlen, H., Dirschinger, J., Hadamitzky, M., Wehinger, A., Hausleiter, J., Walter, H. and Neumann, F.J. (1997) Predictive Factors of Restenosis after Coronary Stent Placement. Journal of the American College of Cardiology, 30, 1428-1436.
http://dx.doi.org/10.1016/S0735-1097(97)00334-3
[23] Hoffmann, R., Mintz, G.S., Pichard, A.D., Kent, K.M., Satler, L.F. and Leon, M.B. (1998) Intimal Hyperplasia Thickness at Follow-Up Is Independent of Stent Size: A Serial Intravascular Ultrasound Study. American Journal of Cardiology, 82, 1168-1172.
http://dx.doi.org/10.1016/S0002-9149(98)00603-1

  
comments powered by Disqus

Copyright © 2019 by authors and Scientific Research Publishing Inc.

Creative Commons License

This work and the related PDF file are licensed under a Creative Commons Attribution 4.0 International License.