Coronary Artery DiseaseMechanical debulking versus balloon angioplasty for the treatment of diffuse in-stent restenosis☆
Section snippets
Study population
Between January 1, 1994, and January 31, 1997, 125 patients underwent percutaneous coronary revascularization for initial management of symptomatic in-stent restenosis at Beth Israel-Deaconess Medical Center. Of these, 34 patients (27%) were treated for focal restenotic lesions (confined predominantly to the stent articulation site or to one of the ends of the stent), and 31 patients (25%) were treated for restenosis in a saphenous vein graft stent. These patients were excluded from this study.
Patient characteristics
Baseline demographic and clinical characteristics of the study population are described in Table I. The treatment groups were generally well matched with respect to age, gender, extent of coronary disease, and type of stent. The median time to restenosis was similar between the debulking and PTCA groups (153 vs 115 days, respectively, p = 0.20). Patients in the debulking group were somewhat more likely to have diabetes mellitus (43% vs 23%, p = 0.10) but had otherwise similar coronary disease
Discussion
With the exponential growth in coronary stent implantation, treatment of in-stent restenosis has become an increasingly frequent challenge. Although many cases of in-stent restenosis can be treated successfully with simple redilation,5, 7 previous studies have shown that patients with a diffuse pattern of in-stent restenosis are at increased risk for recurrent restenosis.8, 9 In this study, we compared the results of treatment for diffuse in-stent restenosis using 2 alternative
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Dr. Cohen was supported in part by a Clinician-Scientist Award from the American Heart Association, Dallas, Texas.
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Author deceased on March 5, 1998.