Zeitschrift für Kardiologie

, Volume 94, Issue 11, pp 742–747 | Cite as

Treatment of in-stent restenosis with sirolimus-eluting-stents—

A six month clinical and angiographic follow-up
  • M. Rau
  • C. Maikowski
  • M. Weber
  • E. Keil
  • A. Elsässer
  • H. Möllmann
  • C. Hamm
ORIGINAL PAPER
Received:
Accepted:

Summary

Treatment of in-stent restenosis (ISR) remains a therapeutic challenge since many pharmacological and mechanical approaches have shown disappointing results except for brachytherapy. Drug-eluting stents (DES) have been reported to effectively reduce ISR in de novo lesions. We studied 55 consecutive patients with ISR in native coronary arteries and 7 with ISR in saphenous vein grafts (SVG) with elective indication for percutaneous coronary intervention (PCI), who underwent successful implantation with DES. No in-hospital postprocedural major adverse cardiac events were observed. All but one patient (n=61) underwent an angiographic follow-up at 183±30 days. Grade of stenosis was assessed by quantitative coronary angiography (QCA) at index procedure and at control angiography. Restenosis (>50%) occurred in 5 patients (8.2%). Target vessel revascularization was performed in an additional 4 patients. Minimal intimal hyperplasia was observed in all segments covered by DES (late loss 0.08±0.37 mm, loss index 0.11±0.47). One patient suffered from subacute stent thrombosis due to discontinuation of clopidogrel medication. At six month follow-up two patients had died. Death was not related to a restenosis in the treated segment. Conclusion Our experiences with DES treatment of ISR lesions show good angiographic and clinical results at index procedure and at the 6 month follow-up with low sub acute thrombosis rate as compared with existing treatment modalities. Restenosis rate seems to be at least as low as reported for brachytherapy.

Key words

Coronary artery disease in-stent restenosis drug-eluting stents 

Behandlung einer In-Stent-Restenose mit Sirolimus-Eluting-Stents—eine 6-monatige klinische und angiographische Nachbehandlung

Zusammenfassung

Die Behandlung der In-Stent-Restenose (ISR) stellt ein bedeutendes Problem der interventionellen Kardiologie dar. Alle pharmakologischen und mechanischen Behandlungsansätze haben, mit Ausnahme der Brachytherapy, bisher enttäuschende Ergebnisse erbracht. Bei de-novo Läsionen sind Drug Eluting Stents (DES) zur Verhinderung der Restenose erfolgreich eingesetzt worden. Bei 55 konsekutiven Patienten mit ISR in Nativgefäßen und 7 mit ISR in Venenbypasses (SVG) mit elektiver Indikation zur Stentimplantation wurde erfolgreich ein Sirolimus Eluting Stent implantiert. Während des stationären Aufenthaltes traten keine Komplikationen auf. Bis auf einen Patienten wurden alle Patienten nach 183±30 Tg. erneut angiographisch untersucht. Der Stenosegrad wurde mittels QCA während der Erstprozedur und bei der Kontrollangiographie bestimmt. Eine In-Stent-Restenose (definiert >50% Restenose) trat bei 5 Patienten (8,2%) auf. Eine erneute Intervention im gleichen Gefäß (TVR) wurde bei weiteren 4 Patienten notwendig. Der Grad der Intimahyperplasie war in allen behandelten Segmenten bei QCA-Messung minimal (late loss 0,08±0,37, loss index 0,11±0,47). Eine Patientin erlitt eine subakute Stentthrombose, die auf das vorzeitige Absetzten von Clopidogrel zurückzuführen war. Beim Follow-up nach 6 Monaten waren 2 Patienten verstorben. Ihr Tod war nicht ursächlich auf eine In-Stent-Restenose zurückzuführen. Die major adverse cardiac event—Rate (MACE) bei der Nachuntersuchung betrug 21% (n=13). Unsere Untersuchung zeigte eine geringe angiographische Restenoserate bei DES und sehr gute klinische Ergebnisse bei der Erstimplantation und nach 6 Monaten. Die Rate subakuter Stentthrombosen war im Vergleich zu bisher üblichen Verfahren gering. Insgesamt scheint die Restenoserate zumindest ebenso gering wie bei der Brachytherapie zu sein.

Schlüsselwörter

Koronare Herzerkrankung In-Stent-Restenose Drug eluting Stents 
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Copyright information

© Steinkopff-Verlag 2005

Authors and Affiliations

  • M. Rau
    • 1
  • C. Maikowski
    • 1
  • M. Weber
    • 1
  • E. Keil
    • 1
  • A. Elsässer
    • 1
  • H. Möllmann
    • 1
  • C. Hamm
    • 1
  1. 1.Department of CardiologyKerckhoff-KlinikBad NauheimGermany

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