Treatment of focal in-stent restenosis with balloon angioplasty alone versus stenting: Short- and long-term results

Roxana Mehran, George Dangas, Alexandre Abizaid, Alexandra J. Lansky, Gary S. Mintz, Augusto D. Pichard, Lowell F. Satler, Kenneth M. Kent, Ron Waksman, Gregg W. Stone, Martin B. Leon

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48 Scopus citations


Background: Although both percutaneous transluminal coronary angioplasty (PTCA) and additional stenting can be used for the treatment for focal in-stent restenosis (ISR), no large-scale comparative data on the clinical outcomes after these interventional procedures have been reported. Methods: In the current study we compared the in-hospital and long-term clinical results of PTCA alone (n = 266 patients, n = 364 lesions) versus stenting (n = 135 patients, n = 161 lesions) for the treatment of focal ISR, defined as a lesion length ≤ 10 mm. Results: There were significantly more diabetic patients in the PTCA group than in the stent group (36% vs 26%, P = .04), but other baseline characteristics were similar. Lesion length and preprocedure minimal lumen diameter (MLD) were also similar in the two groups, but the stent group had a larger reference vessel diameter (3.40 ± 0.73 mm vs 2.99 ± 0.68 mm, P < .001). Stenting achieved a larger postprocedure MLD than PTCA did (2.95 ± 0.95 mm vs 2.23 ± 0.60 mm, P < .001) and a smaller residual diameter stenosis (11% ± 15% vs 23% ± 16%, P = .04). Angiographic success was achieved in all cases. The rate of death/Q-wave infarction of urgent revascularization was higher with PTCA than with stent (5.6% vs 0.7%, P = .02). Postprocedure creatine kinase myocardial band enzyme elevation > 5 times normal was more frequent with stent (18.5% vs 9.7%, P = .05). At 1 year the two interventional strategies had similar cumulative mortality (4.6% PTCA vs 5.1% stent, P not significant) and target lesion revascularization rate (24.6% PTCA vs 26.5% stent, P not significant). By multivariate analysis, the sole predictor of target lesion revascularization was diabetes (odds ratio 2.4, 95% confidence intervals 1.2-4.7, P = .01). Conclusion: Repeat stenting for the treatment of focal ISR had a higher postprocedure creatine kinase myocardial band elevation rate and similar long-term clinical results compared with PTCA alone.

Original languageEnglish
Pages (from-to)610-614
Number of pages5
JournalAmerican Heart Journal
Issue number4
StatePublished - 2001
Externally publishedYes


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