Defeating In-Stent Restenosis: The Bugaboo of Percutaneous Coronary Intervention
Keywords:
Restenosis, hyperplasia, vascular remodeling, neoatherosclerosi, neointimalAbstract
Despite numerous advances in coronary intervention techniques, in-stent restenosis (ISR) remains the Achilles heel of interventional cardiology. The incidence of ISR varies from 10-50% and depends on the absence or presence of several risk factors such as small vessel size, longer lesions, and diabetes. Drug-eluting stents (DES) have dramatically reduced the rates of restenosis and target vessel revascularization in a wide spectrum of patients with varying lesion morphologies. The interventionists must do a strategic evaluation of their patient before doing angioplasty to prevent ISR. Intracoronary imaging might help to understand the mechanism and to decide the management. In this article, we describe and compare the contemporarytreatment modalities in patients who develop ISR. We also describe the role of imaging in the evaluation and characterization of in-stent restenosis. Various modalities of treatment
like balloon angioplasty, cutting and scoring balloon, rotational atherectomy, excimer laser coronary angioplasty (ELCA), drug-coated balloons, drug-eluting stents, brachytherapy, and the role of coronary artery bypass grafting (CABG) have been discussed
References
Eeckhout E, Serruys PW, Wijns W, et al. editors. “The PCR - EAPCI Textbook Percutaneous Interventional Cardiovascular Medicine”. Europa Ed PCR Publ2012:785-826.
Fishman RF, Kuntz RE, Carrozza JP Jr, et al. “Long-term results of directional coronary atherectomy: predictors of restenosis”. J Am CollCardiol20(1992): 1101-1110.
Le Feuvre C, Bonan R, Lespérance J,Gosselin G, Joyal M, et al. “Predictive factors of restenosis after multivessel percutaneous transluminal coronary angioplasty”. Am J Cardiol 73(1994): 840-844.
Bakhai A, Booth J, Delahunty N, Nugara F, Clayton T, McNeill J et al. “The SV stent study: a prospective, multicentre, angiographic evaluation of the BiodivYsiophosphorylcholine coated small vessel stent in small coronary vessels”. Int J Cardiol102(2005): 95-102.
Agostoni P, Valgimigli M, Biondi-Zoccai GG, Abbate A, Garcia HMG, et al. “Clinical effectiveness of bare-metal stenting compared with balloon angioplasty in total coronary occlusions: insights from a systematic overview of randomized trials in light of the drug-eluting stent era”. Am Heart J 151(2006): 682-689.
Stettler C, Wandel S, Allemann S, Kastrati A, Morice MC et al. “Outcomes associated with drug-eluting and bare-metal stents: a collaborative network meta-analysis”. Lancet 370(2007): 937-948.
Kastrati A, Mehilli J, Pache J, Kaiser C, Valgimigli M et al. “Analysis of 14 trials comparing sirolimus-eluting stents with bare-metal stents”. N Engl J Med 356(2007): 1030-1039.
del BG, Cuevas JRR, Hernández HernándezF,Nouche RT et al. “Spanish cardiac catheterization and coronary intervention registry. 22nd official report of the Spanish Society of Cardiology Working Group on Cardiac Catheterization and Interventional Cardiology (1990- 2012)”. Rev EspCardiol (Engl Ed) 66(2013): 894-904.
Moses JW, Leon MB, Popma JJ, Fitzgerald PJ, Holmes DR, et al. “Sirolimus-eluting stents versus standard stents in patients with stenosis in a native coronary artery”. N Engl J Med 20032 349(2003): 1315-1323.
Stone GW, Ellis SG, Cox DA, Hermiller J, S Charles O’, et al. “A polymer-based, paclitaxel-eluting stent in patients with coronary artery disease”. N Engl J Med 350(2004): 221-231.
Buccheri D, Piraino D, Andolina G, Cortese B. “Understanding and managing in-stent restenosis: a review of clinical data, from pathogenesis to treatment”. J Thorac Dis 8(2016): E1150-E1162.
Angioi M, Abdelmouttaleb I, Rodriguez RM, et al. Increased C-reactive protein levels in patients with instent restenosis and its implications. Am J Cardiol87(2001): 1189-1193.
GS Mintz, JJ Popma, Pichard AD, Kent KM, Satler LF, et al. “Arterial remodeling after coronary angioplasty: a serial intravascular ultrasound study”. Circulation 94(1996): 35-43.
Nakazawa G, Otsuka F, Nakano M, Vorpahl M, Yazdani SK, et al. “The pathology of neoatherosclerosis in human coronary implants baremetal and drug-eluting stents”. J Am CollCardiol57(2011): 1314- 1322.
Yonetsu T, Kato K, Kim SJ, Xing L, Jia H, et al. “Predictors for neoatherosclerosis: a retrospective observational study from the optical coherence tomography registry”. CircCardiovasc Imaging 5(2012): 660-666.
Suzuki T, Kopia G, Hayashi S-i, Bailey LR, LlanosG et al. “Stentbased delivery of sirolimus reduces neointimal formation in a porcine coronary model”. Circulation104(2001): 1188–1193.
Sousa JE, Costa MA, Abizaid AC, BJ Rensing, AS Abizaid, et al. “Sustained suppression of neointimal proliferation by sirolimuseluting stents: one-year angiographic and intravascular ultrasound follow-up”. Circulation 104(2001): 2007–2011.
Fuchs S, Kornowski R, Leon MB, Epstein SE et al. “Antiangiogenesis: a new potential strategy to inhibit restenosis”.Int J CardiovascInterv4(2001): 3-6.
Dangas GD, Claessen BE, Caixeta A, Sanidas EA, Mintz GS, et al. “In-stent restenosis in the drugeluting stent era”. J Am CollCardiol56(2010): 1897-907.
Mehran R, Dangas G, Abizaid AS, Mintz GS, Lansky AJ et al. “Angiographic patterns of in-stent restenosis: classification and implications for long-term outcome”. Circulation 100(1999): 1872- 1878.
Kuntz RE, Baim DS. “Defining coronary restenosis. Newer clinical and angiographic paradigms”. Circulation 88(1993): 1310-1323.
Yasuhiro A, Joseph DG. “Optimal approach for treating in-stent restenosis. Cardiac Interventions Today 12(2018): 49-52.
Alfonso F, Cequier A, Angel J,Martí V, Zueco J et al. “Value of the American College of Cardiology/American Heart Association angiographic classification of coronary lesion morphology in patients with in-stent restenosis. Insights from the Restenosis Intra-stent Balloon angioplasty versus elective Stenting (RIBS) randomized trial”. Am Heart J 151(2006): 681.e1-681.e9.
Her AY, Shin ES. “Current Management of In-Stent Restenosis”. Korean Circ J48(2018) :337-349.
Nakazawa G, Otsuka F, Nakano M,Vorpahl M, Yazdani SK, et al. “The pathology of neoatherosclerosis in human coronary implants baremetal and drug-eluting stents”. J Am CollCardiol57(2011): 1314-1322.
Nicolais C, Lakhter V, Virk HU,Sardar P, Bavishi C et al. “Therapeutic options for in-stent restenosis”. CurrCardiol Rep 20(2018): 7.
Hernández RA, Macaya C, Iñiguez A, F Alfonso, Goicolea J, et al. “Midterm outcome of patients with asymptomatic restenosis after coronary balloon angioplasty”. J Am CollCardiol19(1992): 1402-1409.
Neumann FJ, Sousa-Uva M. “Ten commandments’ for the 2018 ESC/EACTS guidelines on myocardial revascularization”. Eur Heart J42(2018):3759.
Levine GN, Bates ER, Blankenship JC, Bailey SR, Bittl JA et al. “2011 ACCF/AHA/SCAI guideline for percutaneous coronary intervention. A report of the American College of Cardiology Fo3undation/ American Heart Association Task Force on Practice Guidelines and the Society for Cardiovascular Angiography and Interventions”. J Am CollCardiol124(2011):e574-e651.
Zhang J, Gao X, Kan J, Ge Z, Han L et al. “Intravascular ultrasound versus angiography-guided drug-eluting stent implantation: The ULTIMATE Trial”. J Am CollCardiol. 72(2018): 3126-3137.
Jensen LO, Vikman S, Antonsen L,Kosonen P, Niemelä M, et al. “Intravascular ultrasound assessment of minimum lumen area and intimal hyperplasia in in-stent restenosis after drug-eluting or baremetal stent implantation. The Nordic Intravascular Ultrasound Study (NIVUS)”. CardiovascRevasc Med18(2017): 577-582.
Prati F, Romagnoli E, Burzotta F, Limbruno U, Gatto L et al. “Clinical impact of OCT findings during PCI: The CLI-OPCI II Study”. JACC Cardiovasc Imaging 8(2015): 1297-1305.
Jones DA, Rathod KS, Koganti S, et al. “Angiography alone versus angiography plus optical coherence tomography to guide percutaneous coronary intervention: outcomes from the Pan-London PCI cohort”. JACC CardiovascInterv 11(2018): 1313-1321.
Choi KH, Song YB, Lee JM, et al. “Impact of intravascular ultrasoundguided percutaneous coronary intervention on long-term clinical outcomes in patients undergoing complex procedures”. JACC CardiovascInterv 12(2019):607-620.
Macander PJ, Roubin GS, Agrawal SK, et al. “Balloon angioplasty for treatment of in-stent restenosis: feasibility, safety, and efficacy”. CathetCardiovascDiagn32(1994): 125-1231.
Alfonso F, Pérez-Vizcayno MJ, Hernández R, et al. “Long-term outcome and determinants of event-free survival in patients treated with balloon angioplasty for in-stent restenosis”. Am J Cardiol83(1999): 1268-1270.
Mehran R, Mintz GS, Popma JJ, et al. “Mechanisms and results of balloon angioplasty for the treatment of in-stent restenosis”.Am J Cardiol78(1996): 618-22.
Alfonso F, Byrne RA, Rivero F, Kastrati A.”Current treatment of instent restenosis.”J Am CollCardiol63(2014): 2659-2673.
Alfonso F, Garcia P, Fleites H, et al. “Repeat stenting for the prevention of the early lumen loss phenomenon in patients with instent restenosis. Angiographic and intravascular ultrasound findings of a randomized study”.Am Heart J 149(2005): e1-e8.
Waksman R and Iantorno M. “Refractory in-stent restenosis: Improving outcomes by standardizing our approach”. CurrCardiol Rep20(2018): 140.
Kufner S, Joner M, Schneider S, et al. “Neointimal Modification With Scoring Balloon and Efficacy of Drug-Coated Balloon Therapy in Patients With Restenosis in Drug-Eluting Coronary Stents: A Randomized Controlled Trial”. JACC CardiovascInterv 10(2017): 1332-1340.
Sharma SK, Kini A, Mehran R, et al. “Randomized Trial of Rotational AtherectomyVersus Balloon Angioplasty for Diffuse In-Stent Restenosis (ROSTER)”. Am Heart J 147(2004): 16-22.
Dahl Jv, Dietz U, Haager PK, et al. “Rotational Atherectomy Does Not Reduce Recurrent In-Stent Restenosis: Results of the Angioplasty Versus Rotational Atherectomy for Treatment of Diffuse In-Stent Restenosis Trial (ARTIST)”. Circulation105(2002): 583-588.
Ferri LA, Jabbour RJ, Giannini F, et al. “Safety and efficacy of rotational atherectomy for the treatment of undilatableunderexpanded stents implanted in calcific lesions”. Catheter CardiovascInterv90(2017): E19-E24.
Latib A, Takagi K, Chizzola G, et al. “Excimer Laser LEsion Modification to Expand Non-Dilatable Stents: The ELLEMENT Registry”. CardiovascRevasc Med 15(2014): 8-12.
Neumann F-J, Sousa-Uva M, Ahlsson A,et al. et al. “2018 ESC/ EACTS Guidelines on myocardial revascularization”. Eur Heart J40(2019): 87‐165.
Scheller B, Hehrlein C, Bocksch W, et al. “Treatment of coronary in-stent restenosis with a paclitaxelcoated balloon catheter”. N Engl J Med 355(2006): 2113-2124.
Byrne RA, Cassese S, Windisch T, et al. “Differential relative efficacy between drug-eluting stents in patients with bare metal and drugeluting stent restenosis; evidence in support of drug resistance: insights from the ISAR-DESIRE and ISAR-DESIRE 2 trials”. EuroIntervention9(2013): 797–802.
Wöhrle J, Zadura M, Möbius-Winkler S, et al. “SeQuentPlease World Wide Registry: clinical results of SeQuent please paclitaxel-coated balloon angioplasty in a large-scale, prospective registry study”. J Am CollCardiol 60(2012): 1733-1738.
Habara S, Mitsudo K, Kadota K, et al. “Effectiveness of paclitaxeleluting balloon catheter in patients with sirolimus-eluting stent restenosis”. JACC CardiovascInterv4(2011): 149-154.
Rittger H, Brachmann J, Sinha AM, et al. “A randomized, multicenter, single-blinded trial comparing paclitaxel-coated balloon angioplasty with plain balloon angioplasty in drug-eluting stent restenosis: the PEPCAD-DES study”. J Am CollCardiol59(2012): 1377-1382.
Xu B, Gao R, Wang J, et al. “A prospective, multicenter, randomized trial of paclitaxel-coated balloon versus paclitaxel-eluting stent for the treatment of drug-eluting stent in-stent restenosis: results from the PEPCAD China ISR trial”. JACC CardiovascInterv7(2014): 204-211.
Indermuehle A, Bahl R, Lansky AJ, et al. “Drug-eluting balloon angioplasty for in-stent restenosis: a systematic review and metaanalysis of randomised controlled trials”. Heart 99(2013): 327-333.
Kastrati A, Mehilli J, von Beckerath N, et al. “Sirolimus-eluting stent or paclitaxel-eluting stent vs balloon angioplasty for prevention of recurrences in patients with coronary in-stent restenosis: a randomized controlled trial”. JAMA 293(2005): 165-1671.
Dibra A, Kastrati A, Alfonso F, et al. “Effectiveness of drug-eluting stents in patients with bare-metal instent restenosis: meta-analysis of randomized trials”. J Am CollCardiol49(2007): 616-623.
Latib A, Mussardo M, Ielasi A, et al. “Long-term outcomes after the percutaneous treatment of drug-eluting stent restenosis”. JACC CardiovascInterv 4(2011): 155-164.
Kastrati A, Byrne R. “New roads, new ruts: lessons from drug-eluting stent restenosis”. JACC CardiovascInterv 4(211): 165–167.
Alfonso F, Perez-Vizcayno MJ, Dutary J, et al. “Implantation of a drugeluting stent with a different drug (switch strategy) in patients with drug-eluting stent restenosis. Results from a prospective multicenter study (RIBS III [Restenosis Intra-stent: Balloon angioplasty versus drug-eluting Stent])”. JACC CardiovascInterv5(2012): 728-737. DOI: 10.47755/J Heart Cardiovac Sci.2020.1.004
Alfonso F, Perez-Vizcayno MJ, Hernandez R, et al. “Long-term clinical benefit of sirolimus-eluting stents in patients with in-stent restenosis results of the RIBS-II (Restenosis Intra-stent: Balloon angioplasty vs. elective sirolimus-eluting Stenting) study”. J Am CollCardiol 52(2008): 1621-167.
Varghese MJ, Bhatheja S, Baber U, Kezbor S, Chincholi A, et al. “Intravascular Brachytherapy for the Management of Repeated Multimetal-Layered Drug-Eluting Coronary Stent Restenosis”. CircCardiovascInterv. 11(2018): 006832.
Negi SI, Torguson R, Gai J, et al. “Intracoronary Brachytherapy for Recurrent Drug-Eluting Stent Failure”. JACC CardiovascInterv 9(2016): 1259-1265.
Siontis G, Stefanini GG, Mavridis D, et al. “Percutaneous coronary interventional strategies for treatment of in-stent restenosis: a network meta-analysis”. Lancet 386(2015): 655‐664.
Giacoppo D, Alfonso F, Xu B, et al. “Paclitaxel-coated balloon angioplasty vs. drug-eluting stenting for the treatment of coronary in-stent restenosis: a comprehensive, collaborative, individual patient data meta-analysis of 10 randomized clinical trials (DAEDALUS study)”. Eur Heart J. 41(2019): 3715-3728.
