Today in Medicine: Implanting the Same vs. Different Drug-Eluting Stent (DES) for the Treatment of DES Restenosis.

June 26th, 2007 By Alexandra Almonacid M.D. [mailto:aalmonacid@partners.org]

Washington DC, USA: Treatment of in-stent restenosis (ISR) remains a clinical challenge for interventional cardiologists. Although clinical recurrence due to restenosis occurs in less than 5% of patients after drug-eluting stent (DES) placement, it may occur as a result of either focal tissue growth within the stent or at its margins. DES reimplantation is generally accepted as the treatment of choice for DES ISR, but it is not clear whether the same or a different DES should be used.

In the last issue of Catheterization and Cardiovascular Intervention, Garg and colleagues from the Washington Hospital Center report the results of a cohort study in patients who underwent reimplantation of drug-eluting stent (DES) for the treatment of DES ISR. A total of 116 patients were included in the study, 53.4% of these patients were treated with a different DES than that which was originally implanted and 46.6% with the same DES.

All patients had clinical follow-up at 30 days, 6 months and 1 year. A major adverse cardiac event (MACE) was defined by death, Q wave MI, and target vessel revascularization (TVR). By six months, TVR-MACE occurred in 14.5% of the patients treated with different DES and in 16.7% with the same DES (p=0.750); at 1 year, TVR-MACE developed in 32.6% of patients treated with a different DES and in 35% treated with the same DES (p=0.814). Irrespective of the type of DES used, the restenosis rates were considerably high (12.2% at 6 months and 28.8% at 1 year).

This study suggests that late outcomes are not affected by whether the same or different DES is used for the treatment of DES in-stent restenosis.


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