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Switching types of drug-eluting stents does not prevent repeated in-stent restenosis in patients with coronary drug-eluting stent restenosis

OBJECTIVES: We treated patients experiencing drug-eluting stent (DES) restenosis with plain old balloon angioplasty (POBA), implantation of the same type of DES [homogeneous drug-eluting stent (HOMO-DES)], or implantation of a different type of DES [heterogeneous drug-eluting stent (HETERO-DES)], an...

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Autores principales: Nojima, Yuhei, Yasuoka, Yoshinori, Kume, Kiyoshi, Adachi, Hidenori, Hattori, Susumu, Matsutera, Ryo, Kohama, Yasuaki, Sasaki, Tatsuya
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Lippincott Williams & Wilkins 2014
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4222797/
https://www.ncbi.nlm.nih.gov/pubmed/25076360
http://dx.doi.org/10.1097/MCA.0000000000000159
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author Nojima, Yuhei
Yasuoka, Yoshinori
Kume, Kiyoshi
Adachi, Hidenori
Hattori, Susumu
Matsutera, Ryo
Kohama, Yasuaki
Sasaki, Tatsuya
author_facet Nojima, Yuhei
Yasuoka, Yoshinori
Kume, Kiyoshi
Adachi, Hidenori
Hattori, Susumu
Matsutera, Ryo
Kohama, Yasuaki
Sasaki, Tatsuya
author_sort Nojima, Yuhei
collection PubMed
description OBJECTIVES: We treated patients experiencing drug-eluting stent (DES) restenosis with plain old balloon angioplasty (POBA), implantation of the same type of DES [homogeneous drug-eluting stent (HOMO-DES)], or implantation of a different type of DES [heterogeneous drug-eluting stent (HETERO-DES)], and compared the efficacy and safety of these procedures for the prevention of repeated in-stent restenosis (ISR). BACKGROUND: In patients with de-novo coronary lesions, DES implantation is associated with a markedly reduced restenosis rate as compared with that associated with a bare metal stent and POBA. However, the optimal management strategy for patients with DES ISR remains unknown. PATIENTS AND METHODS: We identified 191 consecutive DES ISR lesions from 183 patients who required clinically driven revascularization and divided them into three groups according to the treatment: 38 lesions were treated with POBA, 38 with HOMO-DES, and 115 with HETERO-DES. RESULTS: The incidence of target lesion revascularization (TLR) was 42.1% (16/38), 15.8% (6/38), and 16.5% (19/115) in the POBA, HOMO-DES, and HETERO-DES groups (POBA vs. HOMO, HETERO-DES; P=0.002, respectively). Multivariate analysis indicated that diabetes [odds ratio (OR), 3.4], hemodialysis (OR, 7.74), nonfocal ISR patterns (OR, 3.35), previous myocardial infarction (OR, 3.26), and POBA (OR, 8.84) were independent predictors of TLR. CONCLUSION: A strategy involving repeated DES implantation was superior to POBA for preventing recurrent restenosis. Treatment with a different type or generation of DES does not appear to reduce the incidence of TLR. Moreover, we identified certain useful factors for facilitating appropriate and early triage in the patients with repeated DES ISR.
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spelling pubmed-42227972014-11-07 Switching types of drug-eluting stents does not prevent repeated in-stent restenosis in patients with coronary drug-eluting stent restenosis Nojima, Yuhei Yasuoka, Yoshinori Kume, Kiyoshi Adachi, Hidenori Hattori, Susumu Matsutera, Ryo Kohama, Yasuaki Sasaki, Tatsuya Coron Artery Dis Original Research OBJECTIVES: We treated patients experiencing drug-eluting stent (DES) restenosis with plain old balloon angioplasty (POBA), implantation of the same type of DES [homogeneous drug-eluting stent (HOMO-DES)], or implantation of a different type of DES [heterogeneous drug-eluting stent (HETERO-DES)], and compared the efficacy and safety of these procedures for the prevention of repeated in-stent restenosis (ISR). BACKGROUND: In patients with de-novo coronary lesions, DES implantation is associated with a markedly reduced restenosis rate as compared with that associated with a bare metal stent and POBA. However, the optimal management strategy for patients with DES ISR remains unknown. PATIENTS AND METHODS: We identified 191 consecutive DES ISR lesions from 183 patients who required clinically driven revascularization and divided them into three groups according to the treatment: 38 lesions were treated with POBA, 38 with HOMO-DES, and 115 with HETERO-DES. RESULTS: The incidence of target lesion revascularization (TLR) was 42.1% (16/38), 15.8% (6/38), and 16.5% (19/115) in the POBA, HOMO-DES, and HETERO-DES groups (POBA vs. HOMO, HETERO-DES; P=0.002, respectively). Multivariate analysis indicated that diabetes [odds ratio (OR), 3.4], hemodialysis (OR, 7.74), nonfocal ISR patterns (OR, 3.35), previous myocardial infarction (OR, 3.26), and POBA (OR, 8.84) were independent predictors of TLR. CONCLUSION: A strategy involving repeated DES implantation was superior to POBA for preventing recurrent restenosis. Treatment with a different type or generation of DES does not appear to reduce the incidence of TLR. Moreover, we identified certain useful factors for facilitating appropriate and early triage in the patients with repeated DES ISR. Lippincott Williams & Wilkins 2014-12 2014-11-06 /pmc/articles/PMC4222797/ /pubmed/25076360 http://dx.doi.org/10.1097/MCA.0000000000000159 Text en © 2014 Wolters Kluwer Health | Lippincott Williams & Wilkins This is an open-access article distributed under the terms of the Creative Commons Attribution-NonCommercial-NoDerivatives 3.0 License, where it is permissible to download and share the work provided it is properly cited. The work cannot be changed in any way or used commercially. http://creativecommons.org/licenses/by-nc-nd/3.0.
spellingShingle Original Research
Nojima, Yuhei
Yasuoka, Yoshinori
Kume, Kiyoshi
Adachi, Hidenori
Hattori, Susumu
Matsutera, Ryo
Kohama, Yasuaki
Sasaki, Tatsuya
Switching types of drug-eluting stents does not prevent repeated in-stent restenosis in patients with coronary drug-eluting stent restenosis
title Switching types of drug-eluting stents does not prevent repeated in-stent restenosis in patients with coronary drug-eluting stent restenosis
title_full Switching types of drug-eluting stents does not prevent repeated in-stent restenosis in patients with coronary drug-eluting stent restenosis
title_fullStr Switching types of drug-eluting stents does not prevent repeated in-stent restenosis in patients with coronary drug-eluting stent restenosis
title_full_unstemmed Switching types of drug-eluting stents does not prevent repeated in-stent restenosis in patients with coronary drug-eluting stent restenosis
title_short Switching types of drug-eluting stents does not prevent repeated in-stent restenosis in patients with coronary drug-eluting stent restenosis
title_sort switching types of drug-eluting stents does not prevent repeated in-stent restenosis in patients with coronary drug-eluting stent restenosis
topic Original Research
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4222797/
https://www.ncbi.nlm.nih.gov/pubmed/25076360
http://dx.doi.org/10.1097/MCA.0000000000000159
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