Abstract Alain Guidon, Stéphane Cook, Alexandre Berger and Jean-Jacques Goy

Service de cardiologie, Clinique Cecil, Lausanne, Switzerland. Department of Cardiology, University Hospital, Bern, Switzerland.

Abstract

Restenosis after sirolimus-eluting stents (SES) remains a clinical problem. We report our experience with the use a second SES in the fi rst SES to treat in-SES restenosis. Twenty-seven patients with in-SES restenosis were included in the registry. In-SES restenosis was focal in 34%, diffuse in 59% and proliferative in 7%. The procedure was successful in all patients without any acute in-hospital complications. During a mean follow-up of 14 ± 7 months MACE occurred in 8 patients (30%), (1 death, 1 myocardial infarction, 4 target lesion revascularisation, 1 target vessel revascularisation and 1 patient underwent CABG). Nineteen patients (70%) had an event-free outcome. In conclusion SES placement to treat in-SES is safe and feasible and could be considered as a therapeutic option. However the incidence of MACE remains high on a long-term period. The use of stents has significantly improved the outcome of percutaneous coronary interventions (PCI) (1,2). However, despite major advances in angioplasty and stenting, in-stent restenosis remains a major limitation. Recently, drug-eluting stents and especially sirolimus-eluting stents (SES) have emerged as a very promising approach in preventing restenosis, and several different compounds have been shown to have a major impact on both the angiographic and the clinical outcome (6–9). However, even after drug eluting stents implantation in-stent restenosis (ISR) remains and represents a clinical challenge. Several approaches have been proposed to deal with ISR like plain old balloon angioplasty (POBA), rotational atherectomy, brachytherapy (1–3). Few reports are actually available about the use of SES in SES for ISR treatment. We report our experience about the use SES for treating an ISR after SES implantation.

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