Division of Cardiology, Department of Internal Medicine, College of Medicine, Inje University, Busan Paik Hospital, Busan, Korea.
Korean Circ J. 2009 Oct;39(10):408-13. doi: 10.4070/kcj.2009.39.10.408. Epub 2009 Oct 28.
The aim of this study was to evaluate the outcomes of repeated percutaneous coronary intervention (PCI) based on the restenosis pattern in drug-eluting stent (DES) failure.
From April 2003 to March 2006, all 67 patients (67 lesions) at our 3 centers who had DES in-stent restenosis (ISR) were enrolled. The patients were divided into 3 groups: group I had focal edge restenosis, group II had focal body restenosis, and group III had non-focal restenosis. All patients were treated with conventional PCI including plain old balloon angioplasty (POBA), cutting balloon angioplasty (CBA), and repeated DES implantation (Re-DES). Angiographic and clinical one year follow-up results for the 3 groups were evaluated.
Sixteen patients were enrolled in group I, 36 in group II, and 15 in group III. Baseline clinical and angiographic characteristics and the proportion of patients in each group receiving each type of treatment strategy were not significantly different among the groups. Within each group, a comparison of angiographic and clinical outcomes for each therapeutic modality revealed that restenosis rates were not statistically different. Although rates of major adverse cardiac events (MACE) were not statistically different between groups I and II, in group III, MACE were 3-fold higher for the POBA (4/4, 100.0%) and CBA (4/4, 100.0%) subgroups than for Re-DES (1/3, 33.3%) (p=0.06), but the differences did not reach statistical significance.
THE PRESENT STUDY SUGGESTS THAT TREATMENT OF DES ISR SHOULD BE INDIVIDUALIZED ACCORDING TO RESTENOSIS PATTERN: any PCI strategy appears appropriate for focal ISR patterns, while Re-DES might be a better choice for non-focal ISR patterns.
本研究旨在评估药物洗脱支架（DES）失败后基于再狭窄模式的重复经皮冠状动脉介入治疗（PCI）的结果。
从 2003 年 4 月至 2006 年 3 月，我们 3 个中心的所有 67 例（67 处病变）DES 支架内再狭窄（ISR）患者被纳入本研究。患者被分为 3 组：I 组为局灶性边缘再狭窄，II 组为局灶性体部再狭窄，III 组为非局灶性再狭窄。所有患者均接受常规 PCI 治疗，包括普通球囊血管成形术（POBA）、切割球囊血管成形术（CBA）和重复 DES 植入术（Re-DES）。对 3 组患者的血管造影和临床 1 年随访结果进行评估。
I 组 16 例，II 组 36 例，III 组 15 例。各组患者的基线临床和血管造影特征以及接受每种治疗策略的患者比例均无显著差异。在每个组内，对每种治疗方式的血管造影和临床结果进行比较，发现再狭窄率无统计学差异。虽然 I 组和 II 组的主要不良心脏事件（MACE）发生率无统计学差异，但在 III 组中，POBA（4/4，100.0%）和 CBA（4/4，100.0%）亚组的 MACE 发生率是 Re-DES（1/3，33.3%）的 3 倍（p=0.06），但差异无统计学意义。
本研究表明，DES-ISR 的治疗应根据再狭窄模式个体化：任何 PCI 策略似乎都适用于局灶性 ISR 模式，而 Re-DES 可能是治疗非局灶性 ISR 模式的更好选择。
