INTERVENTIONAL CARDIOLOGY AND SURGERY

Routine sirolimus eluting stent implantation for unselected in-stent restenosis: insights from the rapamycin eluting stent evaluated at Rotterdam cardiology hospital (RESEARCH) registry

F Saia, P A Lemos, C A Arampatzis, A Hoye, M Degertekin, K Tanabe, G Sianos, P C Smits, W J van der Giessen, P J de Feyter, R T van Domburg and P W Serruys

Department of Invasive Cardiology, Thoraxcentre, Erasmus University Medical Centre, Rotterdam, the Netherlands

Correspondence to:
Correspondence to:
Professor Patrick W Serruys
Erasmus MC, Thoraxcentre, Kamer Bd 404, Dr Molewaterplein 40, 3015 GD Rotterdam, Netherlands; p.w.j.c.serruys{at}erasmusmc.nl

Objective: To assess the effectiveness of routine sirolimus eluting stent (SES) implantation for unselected patients with in-stent restenosis and to provide preliminary information about the angiographic outcome for lesion subgroups and for different in-stent restenosis patterns.

Design: Prospective, single centre registry.

Setting: Tertiary referral centre.

Patients: 44 consecutive patients (53 lesions) without previous brachytherapy who were treated with SES for in-stent restenosis were evaluated. Routine angiographic follow up was obtained at six months and the incidence of major adverse cardiovascular events was evaluated.

Results: At baseline, 42% of the lesions were focal, 21% diffuse, 26% proliferative, and 11% total occlusions. Small vessel size (reference diameter 2.5 mm) was present in 49%, long lesions (> 20 mm) in 30%, treatment of bypass grafts in 13%, and bifurcation stenting in 18%. At follow up, post-SES restenosis was observed in 14.6%. No restenosis was observed in focal lesions. For more complex lesions, restenosis rates ranged from 20–25%. At the one year follow up, the incidence of death was 0, myocardial infarction 4.7% (n = 2), and target lesion revascularisation 16.3% (n = 7). The target lesion was revascularised because of restenosis in 11.6% (n = 5).

Conclusions: Routine SES implantation is highly effective for focal in-stent restenosis and appears to be a promising strategy for more complex patterns of restenosis.

Abbreviations: RESEARCH, rapamycin eluting stents evaluated at Rotterdam cardiology hospital; SES, sirolimus eluting stent; TIMI, thrombolysis in myocardial infarction

Keywords: sirolimus; drug eluting stent; in-stent restenosis

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