Stenting the stent: initial results and long-term clinical and angiographic outcome of coronary stenting for patients with in-stent restenosis

• Published in: The American journal of cardiology Vol. 85; no. 3; pp. 327 - 332
• Main Authors: Alfonso, Fernando, Cequier, Angel, Zueco, Javier, Morı́s, César, Suárez, Concepción P, Colman, Thierry, Esplugas, Enrique, Pérez-Vizcayno, Marı́a J, Fernández, Cristina, Macaya, Carlos
• Format: Journal Article
• Language: English
• Published: New York, NY Elsevier Inc 01.02.2000; Elsevier; Elsevier Limited
• Subjects: Biological and medical sciences; Cardiology; Clinical outcomes; Coronary Angiography; Disease-Free Survival; Diseases of the cardiovascular system; Female; Follow-Up Studies; Graft Occlusion, Vascular - mortality; Graft Occlusion, Vascular - surgery; Humans; Logistic Models; Male; Medical sciences; Middle Aged; Myocardial Revascularization; Proportional Hazards Models; Radiotherapy. Instrumental treatment. Physiotherapy. Reeducation. Rehabilitation, orthophony, crenotherapy. Diet therapy and various other treatments (general aspects); Reoperation; Spain - epidemiology; Stents; Spain; Human; Endoprosthesis; Reoperation; Prognosis; Radiodiagnosis; Treatment efficiency; Mortality; Coronary artery; Instrumentation therapy; Exploration; Coronary arteriography; Long term; Stent; Morbidity; Restenosis; Treatment; Complication; Evolution
• ISSN: 0002-9149; 1879-1913
• DOI: 10.1016/S0002-9149(99)00741-9

Stent restenosis constitutes a therapeutic challenge affecting an increasing number of patients. Conventional angioplasty and debulking techniques are currently used in these patients. However, the potential role of a second stent implantation in this setting (stenting the stent) remains unknown. Therefore, 65 consecutive patients (12 women, aged 62 ± 11 years) undergoing stent implantation (42 elective and 23 unplanned) for the treatment of in-stent restenosis (diffuse [>10 mm] in 39 [60%]) were studied. Angiographic success was obtained in all patients. Three patients developed hospital complications: 1 died from refractory heart failure and 2 suffered non–Q-wave myocardial infarctions. During follow-up (mean 17 ± 11 months) 1 patient died (noncardiac cause) and only 9 (14%) required target vessel revascularization. Kaplan-Meier event-free survival (freedom from death, myocardial infarction, and target vessel revascularization) at 1 year was 84%. Using Cox analysis, patients with unstable symptoms, a short time to stent restenosis, nonelective stenting, and B2-C lesions tended to have poorer prognosis. After adjustment, nonelective stenting was associated (adjusted RR 2.9, 95% confidence interval [CI] 0.82 to 10.3, p = 0.09) with an adverse clinical outcome. On quantitative angiography (core lab) restenosis was found in 13 of 43 patients (30%) (75% of those eligible). Logistic regression analysis identify restenosis length (adjusted RR 1.43, 95% CI 1.04 to 2.14, p = 0.04), and time to restenosis (adjusted RR 0.67, 95% CI 0.47 to 0.94, p = 0.01) as the only independent predictors of recurrent restenosis. Thus, repeat coronary stenting is a safe and efficacious strategy for the treatment of patients with in-stent restenosis. Both elective and nonelective stenting provide excellent initial results. The long-term clinical and angiographic outcome of these patients is also favorable.