Restenosis Treatment 1995-2001
TCTMD - Fellows Course Slide Sets
RIBS Trial: Stents, Balloons on Par
for In-Stent Restenosis-Usually
presented by Fernando Alfonso, MD, PhD
http://www.tctmd.com/ct/enewsletter-20010322/$user_id/?send_to=http://www.tctmd.com/meeting-news/one.html?news_item_id=2003
Treatment of focal in-stent restenosis with
balloon angioplasty alone versus stenting: Short- and long-term results
Mehran R, et al.
Am Heart J 2001;141:610-4
http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&dopt=Citation&list_uids=11275928
Repeat stenting for the treatment of focal ISR had a higher rate of
postprocedure creatine kinase myocardial band elevation >5 times normal
(18.5% vs 9.7%, P =.05) and similar long-term clinical results compared with
PTCA alone.
http://cardiology.medscape.com/38580.rhtml?srcmp=card-060801
Long-term angiographic follow-up after
successful repeat balloon angioplasty for in-stent restenosis
Galassi AR, et al.
Clin Cardiol 2001;24:334-40
http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&dopt=Citation&list_uids=11303704
Although balloon angioplasty can be safely, successfully, and repeatedly
performed after stent restenosis, it carries a progressively high recurrence of
angiographic restenosis rate during repeat 6-month follow-ups, which was
observed in 24 of the 55 stents (44%) in this study. The subgroup of patients
with diffuse, severe, and/or body location in-stent restenosis proved to be at
higher risk of recurrent restenosis.
Percutaneous and surgical interventions for
in-stent restenosis: long-term outcomes and effect of diabetes mellitus
Moustapha A, et al.
J Am Coll Cardiol 2001;37:1877-82
http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&dopt=Citation&list_uids=11401126
In this large cohort of patients with ISR and in the subset of patients without
diabetes, long-term outcomes were similar in the BA, repeat stent and RA groups.
Tissue debulking with RA yielded better results only in diabetic patients.
Bypass surgery for patients with multivessel disease and ISR provided the best
outcomes.
TCT 2000 Slide Sets
Review
New recipes for in-stent restenosis: cut, grate, roast, or sandwich the neointima?
Di Mario C et al.
Heart 2000;84:471-5
http://www.ncbi.nlm.nih.gov/htbin-post/Entrez/query?db=m&form=6&dopt=r&uid=0011040001
Click here to view the full article
Cutting balloon angioplasty for the treatment of in-stent restenosis
Albiero R || Colombo A
Catheter Cardiovasc Interv 2000;50:452-9
http://www.ncbi.nlm.nih.gov/htbin-post/Entrez/query?db=m&form=6&dopt=r&uid=0010931621
The results using the Cutting Balloon for the treatment of in-stent restenosis may be superior to those of conventional PTCA or even the combination of PTCA preceded by rotational
atherectomy. The reasons for these possible differences are not yet well
defined. The case we report suggests that the Cutting Balloon achieves a better final result than conventional
PTCA, by making the tissue more amenable to being pushed outward through the stent
struts.
In-stent restenosis: long-term outcome and predictors of subsequent target lesion revascularization after repeat balloon angioplasty
Bossi I et al.
J Am Coll Cardiol 2000;35:1569-76
http://www.ncbi.nlm.nih.gov/htbin-post/Entrez/query?db=m&form=6&dopt=r&uid=0010807462
Balloon angioplasty is an effective means of treating in-stent
restenosis. The long-term results are acceptable particularly for focal restenotic
lesions. Further restenosis is more common in patients with early initial
recurrence, more proliferative lesions and a poorer angiographic result from repeat
angioplasty.
BARASTER multicenter registry. Rotational atherectomy or balloon angioplasty in the treatment of intra- stent restenosis
Goldberg SL || Colombo A
Catheter Cardiovasc Interv 2000;51:407-13
http://www.ncbi.nlm.nih.gov/htbin-post/Entrez/query?db=m&form=6&dopt=r&uid=0011108670
The BARASTER registry was formed to evaluate the initial success and long-term results of rotational atherectomy in the management of in- stent
restenosis. Rotational atherectomy was used in 197 cases of in- stent
restenosis: 46 with stand-alone rotational atherectomy or at most 1 atmosphere of balloon inflation (Rota
strategy), and 151 with rotational atherectomy and adjunctive balloon angioplasty <1 atmosphere
(Combination strategy). Results: There was a reduction in one year clinical outcomes
(death, myocardial infarction or target lesion revascularization) in the combination group (38% vs. 60% with Rota and 52% with
balloons, P = 0.02). These data support a benefit of the strategy of debulking with rotational atherectomy followed by adjunctive balloon
angioplasty, in the management of in-stent restenosis.
Treatment of in-stent restenosis with excimer laser coronary angioplasty versus rotational atherectomy: comparative mechanisms and results
Mehran R et al.
Circulation 2000;101:2484-9
http://www.ncbi.nlm.nih.gov/htbin-post/Entrez/query?db=m&form=6&dopt=r&uid=001083152
Despite certain differences in the mechanisms of lumen enlargement, both ELCA+PTCA and RA+PTCA can be used to treat diffuse ISR with similar clinical
results.
High-energy eccentric excimer laser angioplasty for debulking diffuse iIn-stent restenosis leads to better acute- and 6-month follow-up results
Dahm JB et al.
J Invasive Cardiol 2000;12:335-42
http://www.ncbi.nlm.nih.gov/htbin-post/Entrez/query?db=m&form=6&dopt=r&uid=0010904438
A significantly greater diameter than its own diameter can be ablated by the Eccentric Excimer Laser
(eccELCA). Due to a greater debulking effect, additional lumen gain can be achieved immediately and at follow-up through the high-energy use of EccELCA for debulking and through the use of lower balloon inflation pressures for adjunctive
PTCA. Clinical and angiographic TLR is significantly lower than other debulking techniques or PTCA alone and comparable with local irradiation
therapy.
Stenting the stent: initial results and long-term clinical and angiographic outcome of coronary stenting for patients with in-stent restenosis
Alfonso F et al.
Am J Cardiol 2000;85:327-32
http://www.ncbi.nlm.nih.gov/htbin-post/Entrez/query?db=m&form=6&dopt=r&uid=0011078301
Repeat coronary stenting is a safe and efficacious strategy for the treatment of patients with in-stent
restenosis. Both elective and nonelective stenting provide excellent initial
results. The long-term clinical and angiographic outcome of these patients is also favorable
Fate of stent-related side branches after coronary intervention in patients with in-stent restenosis
Alfonso F et al.
J Am Coll Cardiol 2000;36:1549-56
http://www.ncbi.nlm.nih.gov/htbin-post/Entrez/query?db=m&form=6&dopt=r&uid=0011079657
Click here to view the slide
Occlusion or flow deterioration of SB spanned by the ST is relatively common during repeat intervention for in-ST
restenosis. Several factors (mainly anatomic features) are useful predictors of this
event. However, most SB occlusions are clinically silent and frequently reappear at follow-up
TCT 2000 Meeting Coverage
Intracoronary gamma-radiation therapy after
angioplasty inhibits recurrence in patients with in-stent restenosis
Waksman R, et al.
Circulation 2000;101:2165-71.
http://www.ncbi.nlm.nih.gov/htbin-post/Entrez/query?db=m&form=6&dopt=r&uid=10801757
http://www.circulationaha.org/cgi/content/full/101/18/2165
Intracoronary beta-radiation therapy inhibits
recurrence of in-stent restenosis
Waksman R, et al.
Circulation 2000;101:1895-8.
http://www.ncbi.nlm.nih.gov/htbin-post/Entrez/query?db=m&form=6&dopt=r&uid=10779453
http://www.circulationaha.org/cgi/content/full/101/16/1895
Late total occlusion after intracoronary
brachytherapy for patients with in-stent restenosis
Waksman R, et al.
J Am Coll Cardiol 2000;36:65-8.
http://www.ncbi.nlm.nih.gov/htbin-post/Entrez/query?db=m&form=6&dopt=r&uid=10898414
Treatment of in-stent restenosis with excimer
laser coronary angioplasty versus rotational atherectomy: comparative mechanisms
and results
Mehran R, et al.
Circulation 2000;101:2484-9.
http://www.ncbi.nlm.nih.gov/htbin-post/Entrez/query?db=m&form=6&dopt=r&uid=10831522
http://www.circulationaha.org/cgi/content/full/101/21/2484
Optimally deployed stents in the treatment of
restenotic versus de novo lesions
Gruberg L, et al.
Am J Cardiol 2000;85:333-7.
http://www.ncbi.nlm.nih.gov/htbin-post/Entrez/query?db=m&form=6&dopt=r&uid=11078302
Acute and long-term results of treatment of
diffuse in-stent restenosis in aortocoronary saphenous vein grafts
Dangas G, et al.
Am J Cardiol 2000;86:777-9, A6.
http://www.ncbi.nlm.nih.gov/htbin-post/Entrez/query?db=m&form=6&dopt=r&uid=11018200
Intracoronary brachytherapy not associated with
changes in major side branches
Cottin Y, et al.
Catheter Cardiovasc Interv 2000;51:154-8.
http://www.ncbi.nlm.nih.gov/htbin-post/Entrez/query?db=m&form=6&dopt=r&uid=11025567
Early lumen loss after treatment of in-stent
restenosis: an intravascular ultrasound study
Shiran A, et al.
Circulation 1998;98:200-3.
http://www.ncbi.nlm.nih.gov/htbin-post/Entrez/query?db=m&form=6&dopt=r&uid=9697818
Treatment of in-stent restenosis with high
speed rotational atherectomy and IVUS guidance in small <3.0 mm vessels
Schiele F, et al.
Cathet Cardiovasc Diagn 1998;44:77-82.
http://www.ncbi.nlm.nih.gov/htbin-post/Entrez/query?db=m&form=6&dopt=r&uid=9600530
Treatment of in-stent restenosis
Mintz GS, et al.
Semin Interv Cardiol 1998;3:117-21.
http://www.ncbi.nlm.nih.gov/htbin-post/Entrez/query?db=m&form=6&dopt=r&uid=10212502
Coronary-artery stenting compared with balloon
angioplasty for restenosis after initial balloon angioplasty. Restenosis Stent
Study Group
Erbel R, et al.
N Engl J Med 1998;339:1672-8.
http://www.ncbi.nlm.nih.gov/htbin-post/Entrez/query?db=m&form=6&dopt=r&uid=9834304
Mechanical debulking versus balloon angioplasty
for the treatment of diffuse in-stent restenosis
Dauerman HL, et al.
Am J Cardiol 1998;82:277-84.
http://www.ncbi.nlm.nih.gov/htbin-post/Entrez/query?db=m&form=6&dopt=r&uid=9708653
Restenosis revisited--new targets, new
therapies
Libby P, et al.
N Engl J Med 1997;337:418-9.
http://www.ncbi.nlm.nih.gov/htbin-post/Entrez/query?db=m&form=6&dopt=r&uid=9241132
Treatment of in-stent coronary restenosis by
excimer laser angioplasty
Koster R, et al.
Am J Cardiol 1997;80:1424-8.
http://www.ncbi.nlm.nih.gov/htbin-post/Entrez/query?db=m&form=6&dopt=r&uid=9399715
Stenting within a stent: treatment for repeat
in-stent restenosis in a venous graft
Debbas N, et al.
Am Heart J 1997;133:460-3.
http://www.ncbi.nlm.nih.gov/htbin-post/Entrez/query?db=m&form=6&dopt=r&uid=9124169
Management of restenosis after coronary
intervention
Dangas G, et al.
Am Heart J 1996;132:428-36.
http://www.ncbi.nlm.nih.gov/htbin-post/Entrez/query?db=m&form=6&dopt=r&uid=8701907
Restenosis following coronary angioplasty:
clinical presentations and therapeutic options
Levine GN, et al.
Clin Cardiol 1995;18:693-703.
http://www.ncbi.nlm.nih.gov/htbin-post/Entrez/query?db=m&form=6&dopt=r&uid=8608668
Restenosis after percutaneous transluminal
coronary angioplasty: new therapeutic insights from pathogenic mechanisms
Berk BC, et al.
Adv Intern Med 1995;40:445-501
http://www.ncbi.nlm.nih.gov/htbin-post/Entrez/query?db=m&form=6&dopt=r&uid=7747655
Antisense therapy for angioplasty restenosis.
Some critical considerations
Bennett MR, et al.
Circulation 1995;92:1981-93.
http://www.ncbi.nlm.nih.gov/htbin-post/Entrez/query?db=m&form=6&dopt=r&uid=7671381