Sirolimus eluting stent restenosis: impact of angiographic patterns and the treatment factors on angiographic outcomes in contemporary practice

Objective: This study compared the impact of pattern of sirolimus eluting stent restenosis (SES ISR) on the angiographic outcomes following conventional modalities of treatment.

Methods: A total of 344 consecutive patients who underwent treatment for SES ISR were included in the study. Lesions were divided into focal< 10 mm, 156 (45.3%)); and non focal> 10 mm, 188 (54.7%). The endpoints analysed were angiographic restenosis and target lesion revascularisation. A total of 31%, 41%, and 23% patients were treated with cutting balloon angioplasty, balloon angioplasty, and repeat stenting.

Results: Baseline characteristics were similar for two patterns, except for young age, more AMI and severe angina, more CTO lesions, long lesions, and more use of repeat stenting in non focal ISR group. Follow up angiography shows binary restenosis was significantly lower in the focal group (32.4% vs. 49.2; p = 0.012) and target lesion revascularisation were also lower with focal pattern ISR (30.6 vs. 42.9; p = 0.06). Restenosis rates are similar between balloon angioplasty and repeat stenting (28 vs. 23%) in focal ISR group, and repeat stenting showed better outcomes in the non focal group (60% vs. 36%).

Conclusion: The recurrent ISR remains high with available treatments and the pattern of SES ISR predicted the outcomes, with lower restenosis rates with focal pattern of ISR.