Stenting for in-stent restenosis

Intravascular ultrasound studies have shown that additional stent implantat ion is the only percutaneous technique that allows for recovery of all the lumen area of the original implantation procedure. Despite this theoretical advantage, information on systematic additional stent implantation is stil l forthcoming, especially concerning the impact of new stent designs. This prospective study evaluated the efficacy of routine additional stent implan tation for treatment of in-stent restenosis In 68 consecutive patients. Rep eat stenting was successful in all cases, and second-generation tubular ste nts were used in 84% of patients. The mean additional stent length was 19.2 +/- 9.4 mm, and 15% of patients had multiple stent implantation. The postp rocedure minimum lumen diameter was 3.11 +/- 0.41 mm, and the percentage re sidual stenosis was 2% +/- 7%. At a mean clinical follow-up of 10 +/- 8 mon ths (follow-up rate 100%), the incidence of major adverse events was 21% (1 death, 13 target vessel revascularizations). Overall, angiographic resteno sis rate was 32% (angiographic follow-up rate 79%). By multivariate analysi s, the only predictors of recurrence after additional stenting were unstabl e angina at the second procedure (OR 8.70, 95% CI 1.50-50.33, P = 0.019), a nd early clinical recurrence after the first stent procedure (OR 4.83, 95% CI 1.13-20.71, P = 0.038). Additional stenting is a safe and effective trea tment modality for the majority of patients with in-stent restenosis. Alter native treatments should be considered only for patients with in-stent rest enosis presenting as unstable angina or early recurrence after a first sten t procedure, (C) 2000 Wiley-Liss, Inc.