[Treatment of Paclitaxel-eluting stent restenosis with sirolimus-eluting stent implantation: angiographic and clinical outcomes]

Abstract

Introduction and objectives: The best way to treat drug-eluting stent restenosis remains unclear. The aim of this study was to investigate clinical and angiographic outcomes in patients who presented with paclitaxel-eluting stent restenosis and were treated by sirolimus-eluting stent implantation.

Methods: The main strategy adopted at our center for the treatment of patients with paclitaxel-eluting stent restenosis was the implantation of sirolimus-eluting stents. This study included all patients treated in this manner, and data were collected prospectively. Routine angiographic follow-up was scheduled at 6-8 months after the intervention. Angiographic restenosis was defined as a restenosis 50% of the diameter in the segment zone. Clinical follow-up was continued for up to 2 years. The major adverse cardiac events monitored were death, myocardial infarction and target lesion revascularization.

Results: The study cohort comprised 43 consecutive patients. At baseline, 33 (76.7%) had focal restenosis, while the remaining 10 (23.3%) had diffuse restenosis. Angiographic follow-up data were available for 36 (83%) patients. Binary restenosis occurred in 6 (16.7%), and instent late luminal loss was 0.32 +/- 0.54 mm. At 2 years, target lesion revascularization had been carried out in 7 (16.3%) patients, while major adverse cardiac events had occurred in 11 (25.8%).

Conclusions: Implantation of a sirolimus-eluting stent as treatment for paclitaxel-eluting stent failure is a viable therapeutic strategy that was associated in this study with the durable prevention of recurrent restenosis. The 2-year revascularization and major adverse cardiac event rates were high, though they were acceptable for a cohort of such high-risk patients.