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2002, Number S1

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Arch Cardiol Mex 2002; 72 (S1)

Treatment of in-stent restenosis

Gaspar J, Sánchez I

Language: Spanish
References: 19
Page: 64-68
PDF size: 128.30 Kb.


ABSTRACT

The use of stents has significantly reduced post PTCA restenosis rates. However, even with optimal stenting the rate of instent restenosis (ISR) is 8-15%. Thus, the extended use of stents (≥ 85% of angioplasty procedures) has made ISR a growing problem. We review the current interventional approach for treating ISR, where the strategy is dictated by the extent of the restenotic plaque. For focal lesions, redilation with balloon is the therapy of choice. For diffuse lesions, the Cutting BalloonR offers good angiographic results with acceptable recurrence rates; in some selected cases, plaque removal can be helpful with a tendency for better results with rotablation. In centers where brachitherapy is available, this is considered the preferred approach for diffuse ISR. In all ISR cases, the alternatives of continuing medical therapy or surgical therapy should also be considered in the decision-making process.


REFERENCES

  1. Kuntz R, Baim DS: Defining coronary restenosis. Newer clinical and angiographic paradigms. Circulation 1993; 88: 1311-23.

  2. Mudra H, Regar E, Klauss V, Werner F, Henneke KHm Sbarouni E, et al: Serial follow-up after optimized ultrasound-guided deployment of Palmaz-Schatz stent. In-stent neointimal proliferation without significant reference segment response. Circulation 1997; 95: 363-370.

  3. de Jaegre P, Mudra H, Figulla H, Almagor Y, Doucet S, Penn I, et al: Intravascular ultra-sound guided optimized stent deployment. Immediate and 6 months clinical and angiographic results from the Multicenter Ultrasound Stenting in Coronaries Study (MUSIC Study). Eur Heart J 1998; 19: 1214-1223.

  4. Moussa I, Moses J, Di Mario C, Busi G, Reimers B, Kobayashi Y, et al: Stenting after optimal lesion debulking (SOLD) registry: angiographic and clinical outcome. Circulation 1998; 98: 1604-1609.

  5. Mehran R, Dangas G, Abizaid AS, Mintz GS, Lansky AJ, Satler LF: Angiographic patterns of in-stent restenosis. Classification and implications for long term outcome. Circulation 1999; 100: 1872-1878.

  6. Mehran R, Dangas G, Abizaid A, Dansky AJ, Mintz GS, Pichard AD, et al: Treatment of focal in-stent restenosis with balloon angioplasty alone: short and long term results. Am Heart J 2001; 141: 610-614.

  7. Smith SC Jr, Dove JT, Jacobs AK, Kennedy JW, Kereiakes D, Kern MJ, et al: ACC/AHA guidelines for percutaneous coronary interventions: executive summary and recommendations: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (Committee to revise the 1993 Guidelines for Percutaneous Transluminal Coronary Angioplasty). J Am Coll Cardiol 2001; 37: 2215-2238.

  8. Shiram A, Mintz GS, Waksman R, Mehram R, Abizaid A, Kent KM, et al: Early lumen loss after treatment of in-stent restenosis: an intravascular ultrasound study. Circulation 1998; 98: 200-203.

  9. Muramatsu T, Tsukahara R, Ho M, Ito Y, Hirano K, Ishimori H, et al: Efficacy of cutting balloon angioplasty for in-stent restenosis: an intravascular ultrasound evaluation. J Invasive Cardiol 2001; 13: 439-444.

  10. Malhutra S, Sweeny J, Anderson J, Lynch T, Masullo V, Jani S, et al: Early lumen loss after repeat coronary intervention for in-stent restenosis. Cathet Cardiovasc Intervent 2001; 52: 35-38.

  11. Alfonso F, Cequier A, Zueco J, Moris C, Suárez CP, Colman T: Stenting the stent: initial results and long-term clinical and angiographic outcome of coronary stenting for patients with in-stent restenosis. Am J Cardiol 2000; 85: 327-332.

  12. Antoniucci D, Valenti R, Trapani M, Santoro GM, Bolognese L, Taddeuci E, et al: Stenting for in-stent restenosis. Cathet Cardiovasc Intervent 2001; 49: 376-381.

  13. Radke PW, vom Dahl J, Hoffman R, Klues HG, Hosseini M, Jansens U, et al: Three-year follow-up after rotational atherectomy for the treatment of diffuse in-stent restenosis: prediction of MACE. Cathet Cardiovasc Intervent 2001; 53: 334-340.

  14. Mushahwar SS, Ramsdale RR: Escape from true stent jail by use of the rotablator. J Invasive Cardiol 2000; 12: 99-101

  15. Kobayashi Y, Teirstein P, Linnemerier T, Stone G, Leon MB, Moses J: Rotational atherectomy (stentablation) in a lesion with stent underexpansion due to heavily calcified plaque. Cathet Cardiovasc Intervent 2001; 52: 208-211.

  16. Palacios I, Sánchez PL, Malidi NA: The place of directional atherectomy for the treatment of in-stent restenosis. Semin Intervent Cardiol 2000; 5: 209-216.

  17. Ajanai AE, Kim HS, Waksman R: Clinical trials of brachytherapy for in-stent restenosis: update. Cardiovasc Radiat Med 2001; 2: 107-113.

  18. Latchem DR, Urban P, Goy JJ, De Benedetti E, Pica A, Coucke P, et al: Beta-radiation for instent restenosis. Cathet Cardiovasc Intervent 2001; 51: 422-429.

  19. Serruys P: Why I should get involved in brachytherapy. Conferencia presentada en el Paris Revascularization Course. Paris, Mayo 22, 2001.




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