Coronary Artery DiseaseClinical and angiographic predictors of recurrent restenosis after percutaneous transluminal rotational atherectomy for treatment of diffuse in-stent restenosis
Section snippets
Patient selection
Patients with a first in-stent restenosis in native coronary arteries fulfilling the following criteria were prospectively and consecutively recruited: inclusion criteria: angina pectoris and/or myocardial ischemia related to the target lesion, diameter stenosis >50% within or 5 mm proximal or distal to the stent edges, and stents implanted ≥3 months before this intervention; exclusion criteria: stents deployed at or directly distal to a bend of >45°, coil stents, recurrent in-stent restenosis,
Patient characteristics and stent implantation
One hundred consecutive patients (70 men, aged 58 ± 11 years) were studied. Demographic, clinical, and angiographic characteristics are outlined in Table I. In 57 patients, the initial stent implantation was the first percutaneous intervention, and 34 patients including 20 patients with stenting for restenosis had ≥1 previous nonsurgical coronary intervention.
The indication for stent implantation was a de novo lesion in 80% including chronic occlusions in 28% and a restenosed artery in 20%.
Discussion
The results, although preliminary with regard to long-term follow-up, indicate that PTRA is a feasible and safe approach for treating symptomatic diffuse in-stent restenosis and achieves excellent acute results; there is clear tissue debulking within the restenosed lesion using PTRA; and the angiographic long-term outcome demonstrates good results in short or medium length (≤20 mm) lesions, whereas long and very diffuse lesions revealed a less favorable outcome.
References (30)
- et al.
Management of restenosis within the Palmaz-Schatz coronary artery stent (the US multicenter experience)
Am J Cardiol
(1993) - et al.
Mechanisms of restenosis and redilation within coronary stents-quantitative angiographic assessment
J Am Coll Cardiol
(1993) - et al.
Immediate and long-term outcomes of rotational atheterectomy versus balloon angioplasty alone for treatment of diffuse in-stent restenosis
Am J Cardiol
(1998) - et al.
Edge detection versus densitometry for assessing coronary stenting quantitatively
Am J Cardiol
(1991) - et al.
Quantification of the minimal luminal cross-sectional area after coronary stenting by two- and three-dimensional intravascular ultrasound versus edge detection and videodensitometry
Am J Cardiol
(1996) - et al.
Serial intravascular ultrasound studies fail to show evidence of chronic Palmaz-Schatz stent recoil
Am J Cardiol
(1995) - et al.
Long-term follow-up after successful repeat percutaneous intervention for stent restenosis
J Am Coll Cardiol
(1997) - et al.
In-stent restenosisthe Washington Hospital Center experience
Am J Cardiol
(1998) - et al.
Mechanism of balloon angioplasty of in-stent restenosisan intravascular ultrasound study
J Am Coll Cardiol
(1995) - et al.
High speed rotational atherectomyoutcome in calcified and noncalcified coronary artery lesions
J Am Coll Cardiol
(1995)
Comparison of early and recent results with rotational atherectomy
J Am Coll Cardiol
Balloon angioplasty for treatment of in-stent restenosisfeasibility, safety, and efficacy
Cathet Cardiovasc Diagn
Six-month angiographic outcome after successful repeat percutaneous intervention for in-stent restenosis
Circulation
Treatment of in-stent restenosis with excimer laser coronary angioplastymechanisms and results compared with PTCA alone
Circulation
High-speed rotational atherectomy for in-stent restenosis
Cathet Cardiovasc Diagn
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Treatment of intrastent restenosis
2004, Pathologie BiologiePredictors of <sup>32</sup>P β brachytherapy failure in patients with high-risk in-stent restenosis
2004, Cardiovascular Radiation MedicineRandomized trial of Rotational Atherectomy Versus Balloon Angioplasty for Diffuse In-stent Restenosis (ROSTER)
2004, American Heart JournalAngiographic analysis of the angioplasty versus rotational atherectomy for the treatment of diffuse in-stent restenosis trial (ARTIST)
2002, American Journal of CardiologyCitation Excerpt :These findings have raised the hope that the recurrence rate could be lowered by ablation of the neointima. Initial investigations utilizing rotational ablation proved efficacy in neointimal removal by this method, and in long-term results the restenosis rate of diffuse ISR tended to be lower than after PTCA.18,19 In contrast to these preliminary findings, results of this larger randomized investigation documented a higher restenosis rate after PTCR than after PTCA of diffuse ISR in general.