Published Online
on May 17, 2004

A more recent version of this article appeared on June 1, 2004

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Submitted on February 10, 2004
Revised on April 8, 2004
Accepted on April 12, 2004

Post-Sirolimus-Eluting Stent Restenosis Treated With Repeat Percutaneous Intervention. Late Angiographic and Clinical Outcomes

Pedro A. Lemos MD, PhD, Carlos A.G. van Mieghem MD, Chourmouzios A. Arampatzis MD, Angela Hoye MB, ChB, MRCP, Andrew T.L. Ong MBBS, FRACP, Eugene McFadden MB, ChB, FRCPI, Georgios Sianos MD, PhD, Willem J. van der Giessen MD, PhD, Pim J. de Feyter MD, PhD, Ron T. van Domburg PhD, and Patrick W. Serruys MD, PhD^*

From Erasmus Medical Center, Thoraxcenter, Rotterdam, the Netherlands.

^* To whom correspondence should be addressed. E-mail: p.w.j.c.serruys{at}erasmusmc.nl.

Background--We evaluated the clinical and angiographic outcomes of patients presenting with restenosis after sirolimus-eluting stent (SES) implantation treated with repeated percutaneous intervention.

Methods and Results--A total of 24 consecutive patients have undergone repeated percutaneous intervention to treat post-SES restenosis (27 lesions). The restenosis was located within the stent in 93% of lesions. From the 27 lesions, 1 (4%) was re-treated with a bare stent, 3 (11%) were treated with balloon dilatation, and the remaining 23 lesions (85%) were treated with repeated drug-eluting stent implantation (SES in 12 lesions [44%], paclitaxel-eluting stents in 11 lesions [41%]). The event-free survival rate was 70.8% after a median follow-up of 279 days from the post-SES treatment. The overall recurrent restenosis rate was 42.9%. The risk of recurrent restenosis was increased for patients with hypercholesterolemia, previous angioplasty, failed brachytherapy, post-SES restenosis needing early (<6 months) treatment, and post-SES restenosis treated with balloon dilatation. The recurrent restenosis rate of originally de novo lesions re-treated with drug-eluting stents was 18.2%.

Conclusions--Even though de novo lesions treated with SES at baseline and re-treated with drug-eluting stents had reasonably better outcomes than other lesion types and strategies, our study shows that the treatment of post-SES restenosis is currently suboptimal and warrants further investigation.

Key words: atherosclerosis • coronary disease • restenosis • stents

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