Repeat intervention for in-stent restenosis: re-expansion of the initial stent is a predictor of recurrence of restenosis

Background In-stent restenosis has become a significant clinical problem as use of stents has increased, The optimal strategy for dealing with in-sten t restenosis needs to be evaluated. Objective To compare the acute and late results of interventions for in-ste nt restenosis according to the device used, and to analyze the clinical and procedural variables of the lesions treated and identify the determinants of recurrence of restenosis and target lesion revascularization (TLR), Methods Procedural and late outcomes for 58 lesions in 50 patients who unde rwent repeat intervention for in-stent restenosis were analyzed. The result s of interventions according to the device employed were compared, The pred ictors of recurrence of restenosis and TLR within 6 months were analyzed, T he ratio of balloon diameter in repeat intervention to minimal lumen diamet er after initial stenting (MLDo) was used as an index of re-expansion of st ents, Serial intravascular ultrasound imaging was performed before and afte r repeat intervention for 33 lesions, and re-expansion of the initial stent was evaluated, Results Repeat intervention was successful in treating all lesions. Angiogr aphic follow-up was possible for 49 lesions (84%) The overall incidences of recurrence of restenosis and TLR were 40.1 and 27.6%, respectively, Despit e the immediate results having been good, the late results of stenting for in-stent restenosis were not favorable. Diffuse-type in-stent restenosis, e arly in-stent restenosis, and balloon diameter:MLDo ratio > 1.25 are indepe ndent predictors of poor late results, Intravascular ultrasound findings ha ve shown that expansion of the initial stent leads to recurrence of resteno sis and TLR. Conclusions Re-expansion of the initial stent can cause further vascular in jury and there is a risk of recurrence of restenosis. Alternative therapeut ic strategies that work without dilating the initial stent may be necessary for treating lesions with high risk of recurrence of restenosis. Coron Art ery Dis 11:451-457 (C) 2000 Lippincott Williams & Wilkins.