Treatment of Palmaz-Schatz in-stent restenosis: 6-Month clinical follow-up
To identify predictors of Palmaz-Schatz in-stent restenosis and determine outcomes of treatment, we assessed 6-month outcomes in 402 patients who had coronary intervention with stent placement; 60 (15%) developed angiographic and clinical evidence of restenosis. Predictors of restenosis included family history of cardiovascular disease, prior bypass surgery, nonelective stenting, stenting of a vein graft, and multiple stents. Of 60 patients with stent restenosis, 47 had repeat percutaneous intervention and 10 had bypass surgery; only 1 of these 10 patients developed symptoms requiring repeat revascularization. Of the 47 with repeat percutaneous intervention, 32 (68%) had conventional balloon angioplasty; the others had perfusion balloon catheters, laser ablation, and repeat coronary stenting. During follow-up, 22 (47%) of these 47 patients suffered recurrent angina, myocardial infarction, or death. A third revascularization procedure was performed in 14 (30%), including 5 referred for bypass. This study shows the limitations of percutaneous modalities for patients with Palmaz-Schatz in-stent restenosis. Such patients are likely to have recurrent symptoms and to undergo repeat target-vessel revascularization.
Huay-Cheem, TAN; Crowley, J; Tcheng, JE; Li-Wah, SNG; Sketch, MH; Phillips, HR; Peter, RH; Behar, VS; Stack, RS; Zidar, JP
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