Ajani Andrew E, Yan Bryan P, Clark David J, Eccleston David, Walton Anthony, Lew Robert, Meehan Adam, Brennan Angela, Reid Chris, Duffy Stephen J
Department of Cardiology, Royal Melbourne Hospital, Melbourne, Australia.
Heart Lung Circ. 2007 Aug;16(4):269-73. doi: 10.1016/j.hlc.2007.02.089. Epub 2007 Apr 6.
Optimal treatment of in-stent restenosis (ISR) remains uncertain in the era of drug-eluting stents (DES). This study aims to determine contemporary treatment of ISR and to assess recurrent ISR rates in the era of DES.
We examined 60 patients presenting for treatment of ISR (one lesion per patient) who were enrolled in the Melbourne Interventional Group Registry (4% of total population of 1423 patients) between April 2004 and January 2005. Twelve-month follow-up is complete for all patients.
The majority of ISR treated occurred in bare metal stents [BMS (n=52, 87%)] and had a focal (<10 mm) pattern of ISR (53%). In-stent restenosis of DES occurred in eight (13%) patients. The majority of ISR were treated with additional stenting with a preference for DES over BMS in almost all cases. At 12 months, one patient died of non-cardiac cause and four patients (7%) presented with recurrent ISR. The incidence of recurrent ISR in DES was 5% (n=3). No late thrombosis was reported despite only 50% of patients having >or=12 months of clopidogrel therapy.
Our study suggests drug-eluting stents are safe, effective and the preferred therapy for in-stent restenosis. The incidence of recurrent drug-eluting stent restenosis at 12 months is low.
在药物洗脱支架（DES）时代，支架内再狭窄（ISR）的最佳治疗方法仍不明确。本研究旨在确定DES时代ISR的当代治疗方法，并评估再发ISR的发生率。
我们对2004年4月至2005年1月期间纳入墨尔本介入组登记处（1423例患者总数的4%）的60例因ISR接受治疗的患者（每位患者1个病变）进行了研究。所有患者均完成了12个月的随访。
接受治疗的ISR大多发生在裸金属支架[BMS（n = 52，87%）]中，且ISR呈局灶性（<10 mm）模式（53%）。8例（13%）患者发生了DES内支架再狭窄。大多数ISR通过再次置入支架进行治疗，几乎在所有情况下都更倾向于使用DES而非BMS。12个月时，1例患者死于非心脏原因，4例患者（7%）出现再发ISR。DES组再发ISR的发生率为5%（n = 3）。尽管只有50%的患者接受了≥12个月的氯吡格雷治疗，但未报告晚期血栓形成。
我们的研究表明，药物洗脱支架对于支架内再狭窄是安全、有效的，且是首选治疗方法。12个月时药物洗脱支架再狭窄的发生率较低。
