Copyright © 2004 by the European Society of Cardiology.
Clinical research
Treatment of in-stent restenosis using a paclitaxel-eluting stent: acute results and long-term follow-up of a matched-pair comparison with intracoronary ß-radiation therapy
a Medical Clinic I, RWTH University Hospital, Pauwelsstraße 30, 52057 Aachen, Germany
b Department of Radio-Oncology, University Hospital of Aachen, Aachen, Germany
c Heart Centre Siegburg, Siegburg, Germany
* Corresponding author. Tel.: +49-241-8089301; fax: +49-241-8880209
E-mail address: PRadke{at}ukaachen.de
Received 30 October 2003; revised 5 February 2004; accepted 13 February 2004 See Page 898 for the editorial comment on this article1
Abstract
Aims Intracoronary radiation therapy (ICR) has significantly improved the long-term outcome after treatment of diffuse in-stent restenosis (ISR). The efficacy of drug eluting stents in this setting remains less well defined. This matched-pair analysis compared the procedural and long-term clinical and angiographic outcome after treatment of diffuse ISR using a paclitaxel-eluting stent (PES) with intracoronary ß-radiation therapy.
Methods and Results Twenty-two patients receiving 25 PES (ACHIEVETM, Cook, 3.1 µg paclitaxel per square millimeter, non-polymer based coating) for ISR underwent 6-month angiographic and 12-month clinical follow-up. From a database including 141 patients (174 lesions) undergoing intracoronary ß-radiation for ISR, 25 lesions (25 patients) were pair-matched with the former group for lesion length and vessel size. PES implantation and ICR were successfull in all patients with a significantly lower postprocedural in-stent diameter stenosis in the PES group (8±12% vs. 18±8%, 
). Angiographic binary in-lesion restenosis at 6 month was 20% (5/25 lesions) in the PES group and 16% (4/25) in the ICR group (
). PES implantation resulted in significantly higher in-stent MLD at FU (2.10±0.71 vs. 1.75±0.36, 
) and a higher in-stent net gain (PES: 1.19±0.69, ICR: 0.84±0.49, 
). Two patients in the PES group and 6 patients in the ICR group experienced a target lesion revascularisation at 12-month follow-up (
).
Conclusion Implantation of a non-polymer based paclitaxel-elution stent and conventional ICR therapy for complex ISR lead to comparable acute and long-term clinical and angiographic follow-up results.
Key Words: Stent • Restenosis • Brachytherapy • Drug-eluting stent • Paclitaxel
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EHJ 2004 25: 898-899.[Extract] [FREE Full Text]
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