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Drug-Eluting Stents and In-Stent Restenosis

Drug-Eluting Stents and In-Stent Restenosis Letters Section Editor: Robert M. Golub, MD, Senior Editor. To the Editor: From a practical standpoint, detailing the logistics required to administer the 600-mg clopidogrel pretreatment 2 hours before intervention, as was done in the study by Dr Kastrati and colleagues,1 will be helpful, considering that in most centers patients with in-stent restenosis undergo ad hoc reintervention, and only complex cases are scheduled for staged procedures. In addition, it would be valuable to identify potential predictors of drug-eluting stent failure to provide early triage and, eventually, to divert patients to alternative techniques.2-4 In this regard, although lesion length was not an exclusion criterion, the baseline median lesion length in the study was only 12 mm, and median stent length was twice as long. Therefore, knowing the criteria used to select stent length and the results of stent use in long lesions would be of major interest. Likewise, studies using intravascular ultrasound have demonstrated that drug-eluting stent underexpansion is a major predictor of late recurrences in this situation.5 Accordingly, assessing the prognostic influence of maximal pressure and selected balloon-to-vessel ratio would be important. In patients assigned to drug-eluting stent use, balloon predilatation was left to the operator’s discretion. It would be helpful to know if the results of direct drug-eluting stent implantation were similar to those obtained after predilatation, as well as the strategy selected for predilatation. References 1. Kastrati A, Mehilli J, von Beckerath N. et al. Sirolimus-eluting stent or paclitaxel-eluting stent vs balloon angioplasty for prevention of recurrences in patients with coronary in-stent restenosis: a randomized controlled trial. JAMA. 2005;293:165-17115644543Google ScholarCrossref 2. Alfonso F, Zueco J, Cequier A. et al. A randomized comparison of repeat stenting with balloon angioplasty in patients with restenosis after coronary stenting. J Am Coll Cardiol. 2003;42:796-80512957423Google ScholarCrossref 3. vom Dahl J, Dietz U, Haager PK. et al. Rotational atherectomy does not reduce recurrent in-stent restenosis: results of the angioplasty versus rotational atherectomy for treatment of diffuse in-stent restenosis trial (ARTIST). Circulation. 2002;105:583-58811827923Google ScholarCrossref 4. Albiero R, Silber S, Di Mario C. et al. Cutting balloon versus conventional balloon angioplasty for the treatment of in-stent restenosis: results from the restenosis cutting balloon evaluation trial (RECUT). J Am Coll Cardiol. 2004;43:943-94915028348Google ScholarCrossref 5. Fujii K, Mintz GS, Kobayashi Y. et al. Contribution of stent underexpansion to recurrence after sirolimus-eluting stent implantation for in-stent restenosis. Circulation. 2004;109:1085-108814993129Google ScholarCrossref http://www.deepdyve.com/assets/images/DeepDyve-Logo-lg.png JAMA American Medical Association

Drug-Eluting Stents and In-Stent Restenosis

Alfonso, Fernando
JAMA , Volume 293 (15) – Apr 20, 2005
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References (6)

Publisher
American Medical Association
Copyright
Copyright © 2005 American Medical Association. All Rights Reserved.
ISSN
0098-7484
eISSN
1538-3598
DOI
10.1001/jama.293.15.1855-a
Publisher site
See Article on Publisher Site

Abstract

Letters Section Editor: Robert M. Golub, MD, Senior Editor. To the Editor: From a practical standpoint, detailing the logistics required to administer the 600-mg clopidogrel pretreatment 2 hours before intervention, as was done in the study by Dr Kastrati and colleagues,1 will be helpful, considering that in most centers patients with in-stent restenosis undergo ad hoc reintervention, and only complex cases are scheduled for staged procedures. In addition, it would be valuable to identify potential predictors of drug-eluting stent failure to provide early triage and, eventually, to divert patients to alternative techniques.2-4 In this regard, although lesion length was not an exclusion criterion, the baseline median lesion length in the study was only 12 mm, and median stent length was twice as long. Therefore, knowing the criteria used to select stent length and the results of stent use in long lesions would be of major interest. Likewise, studies using intravascular ultrasound have demonstrated that drug-eluting stent underexpansion is a major predictor of late recurrences in this situation.5 Accordingly, assessing the prognostic influence of maximal pressure and selected balloon-to-vessel ratio would be important. In patients assigned to drug-eluting stent use, balloon predilatation was left to the operator’s discretion. It would be helpful to know if the results of direct drug-eluting stent implantation were similar to those obtained after predilatation, as well as the strategy selected for predilatation. References 1. Kastrati A, Mehilli J, von Beckerath N. et al. Sirolimus-eluting stent or paclitaxel-eluting stent vs balloon angioplasty for prevention of recurrences in patients with coronary in-stent restenosis: a randomized controlled trial. JAMA. 2005;293:165-17115644543Google ScholarCrossref 2. Alfonso F, Zueco J, Cequier A. et al. A randomized comparison of repeat stenting with balloon angioplasty in patients with restenosis after coronary stenting. J Am Coll Cardiol. 2003;42:796-80512957423Google ScholarCrossref 3. vom Dahl J, Dietz U, Haager PK. et al. Rotational atherectomy does not reduce recurrent in-stent restenosis: results of the angioplasty versus rotational atherectomy for treatment of diffuse in-stent restenosis trial (ARTIST). Circulation. 2002;105:583-58811827923Google ScholarCrossref 4. Albiero R, Silber S, Di Mario C. et al. Cutting balloon versus conventional balloon angioplasty for the treatment of in-stent restenosis: results from the restenosis cutting balloon evaluation trial (RECUT). J Am Coll Cardiol. 2004;43:943-94915028348Google ScholarCrossref 5. Fujii K, Mintz GS, Kobayashi Y. et al. Contribution of stent underexpansion to recurrence after sirolimus-eluting stent implantation for in-stent restenosis. Circulation. 2004;109:1085-108814993129Google ScholarCrossref

Journal

JAMA – American Medical Association

Published: Apr 20, 2005

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