Article Text

Download PDFPDF
130 Repeat percutaneous revascularisation after coronary stenting: a single centre 9 year experience
  1. A Malhotra,
  2. N Evans,
  3. D Adlam,
  4. D Miglani,
  5. G Mole,
  6. A Stockenhuber,
  7. C Forfar
  1. Oxford Heart Centre, John Radcliffe Hospital, Oxford, UK


Introduction Repeat revascularisation after coronary angioplasty and stenting is well recognised, a feature of most prospective trials of percutaneous intervention (PCI) and is a major difference reported in trials comparing surgical to percutaneous revascularisation strategies. We investigated outcomes and repeat procedures in some 25 000 consecutive patients over 9 years from a UK teaching hospital.

Methods Between January 2001 and August 2009, 24 521 patients presented to the John Radcliffe Hospital Oxford for coronary angiography. Revascularisation procedures in the follow-up period were analysed using the procedural database, stored angiographic images and from casenote review.

Results 10 697 (43.6%) underwent PCI with stenting, 832 (3.4%) PCI alone, 4589 (18.7%) coronary artery bypass surgery (CABG) and 8133 (33.2%) medical treatment. Two thousand four hundred and seventy-seven of the 10 697 stented patients (23.2%) returned for a second angiogram and 1314 (12.3%) underwent further stenting and 211 (2.0%) CABG over a median follow-up of 4.25 years (IQR 2.13–6.13 years). Three hundred and eighty-four patients (29.2%) of those requiring a second stenting procedure underwent a third angiogram during the follow-up period and 161 (12.3%) underwent further stenting and 33 (2.5%) CABG. Rates of stenting for the fourth, fifth and sixth procedures were respectively 21%, 24% and 38% representing 0.3%, 0.1% and 0.02% of the initial stented cohort (Abstract 130 Figure 1). 59.9% of repeat PCI stenting procedures were elective, 38.1% urgent and 1.5% primary. Clinical indications for repeat stenting are shown in Abstract 130 Figure 2. A minority of patients (15.7%) required restenting for in-stent restenosis with most patients returning either with disease progression in an unstented area (45.2%) or for staged PCI (25.2%). Stent thrombosis as an indication for repeat stenting was rare (3.3%). Of those requiring restenting, 37.2% patients received drug eluting stents (DES) in their first stenting procedure and 62.8% received bare metal stents (BMS) alone. 5.4% of patients had both DES and BMS in the same procedure. This did not differ significantly from the ratio of DES/BMS in those patients undergoing stenting who did not require further revascularisation in the follow-up period (39% DES, 61% BMS, 14.8% both DES and BMS). 19.3% people requiring a second stenting procedure had multi vessel stenting at first PCI.

Abstract 130 Figure 1

Patient undergoing multiple restenting procedures.

Abstract 130 Figure 2

Most common indications for restenting procedures.

Conclusion and Implications This study shows that in a large unselected ‘real world’ cohort of patients undergoing stenting, a substantial minority of patients undergoing a first stenting procedure will require repeat assessment (23%) and/or repeat stenting (12%). However the driving force behind repeat stenting procedures is progression of disease distant from the site of the first stent (45%) and staged PCI (25%) rather than isolated stent-related restenosis which accounts for under 16% of second stenting procedures and thus a minority of restenting cases.

  • percutaneous intervention
  • restenosis
  • stenting

Statistics from

Request Permissions

If you wish to reuse any or all of this article please use the link below which will take you to the Copyright Clearance Center’s RightsLink service. You will be able to get a quick price and instant permission to reuse the content in many different ways.