Mid-Term Follow-Up of Drug-Eluting Stenting for In-Stent Restenosis: Bare-Metal Stents versus Drug- Eluting Stents

Background: despite major advances in percutaneous coronary intervention (pci), in-stent restenosis (isr) remains a therapeutic challenge. we sought to compare the mid-term clinical outcomes after treatment with repeat drug-eluting stent (des) implantation (“des sandwich” technique) with des placement in the bare-metal stent (des-in-bms) in a real world setting. methods: we retrospectively identified and analyzed clinical and angiographic data on 194 patients previously treated with the des who underwent repeat pci for isr with a des or a bms. isr was defined, by visual assessment, as a luminal stenosis greater than 50% within the stent or within 5 mm of its edges. we recorded the occurrence of major adverse cardiac events (mace), defined as cardiac death, non-fatal myocardial infarction, and the need for target vessel revascularization (tvr). results: of the 194 study participants, 130 were men (67.0%) and the mean ± sd of age was 57.0 ± 10.4 years, ranging from 37 to 80 years. in-hospital events (death and q-wave myocardial infarction) occurred at a similar frequency in both groups. outcomes at twelve months were also similar between the groups with cumulative clinical mace at one-year follow-up of 9.6% and 11.3% in the des-in-bms and the des-in-des groups, respectively (p value = 0.702). although not significant, there was a trend toward a higher tvr rate in the intra-des isr group as compared to the intra-bms isr group (0.9% bms vs. 5.2% des; p value = 0.16). conclusion: our study suggests that the outcome of the patients presenting with isr did not seem to be different between the two groups of des-in-des and des-in-bms at one-year follow-up, except for a trend toward more frequent tvr in the des-in-des group. repeat des implantation for des restenosis could be feasible and safe with a relatively low incidence of mace at mid-term follow-up.