Coronary In-Stent Restenosis: Predictors and Treatment.
In: Deutsches Ärzteblatt International, Jg. 118 (2021-09-24), Heft 38, S. 637-647
Online
academicJournal
Zugriff:
Background: Despite the use of modern drug-eluting stents (DES), in-stent restenosis (ISR) may still occur in as many as 2-10% of percutaneous coronary interventions (PCI) in certain lesion/patient subsets. ISR causes increased morbidity after stent implantation; acute myocardial infarction is a frequent correlate to a clinical ISR, arising in 5-10% of cases. Compared to de novo stenosis, patients with ISR also present more frequently with symptoms of unstable angina pectoris (45% versus 61%). In this article, we discuss the risk factors for ISR and the corresponding diagnostic measures and effective treatment strategies. Methods: This review is based on pertinent publications retrieved by a selective search in PubMed, with special attention to current international guidelines and specialist society recommendations. Results: The type of implanted stent, the presence of diabetes mellitus, previous bypass surgery, and small vessel caliber are predictors for ISR. In their guidelines, the European specialist societies (ESC/EACTS) recommend repeated PCI with DES implantation or drug-coated balloon (DCB) angioplasty as the methods of choice for the treatment of ISR. This approach is supported by evidence from meta-analyses. The RIBS-IV trial showed that revascularization treatment of the target lesion is needed less often after everolimus-eluting stent (EES) implantation than after DCB dilatation (11 [7.1%] versus 24 [15.6%]; p = 0.015; hazard ratio: 0.43; 95% confidence interval: [0.21; 0.87]). Conclusion: Because the pathogenesis of ISR is multifactorial, differentiated risk stratification is necessary. The identification of patient-, stent-, and lesion-related predictors is particularly important, as the most effective way to combat ISR is to prevent it. [ABSTRACT FROM AUTHOR]
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Coronary In-Stent Restenosis: Predictors and Treatment.
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Autor/in / Beteiligte Person: | Ullrich, Helen ; Olschewski, Maximilian ; Münzel, Thomas ; Gori, Tommaso |
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Zeitschrift: | Deutsches Ärzteblatt International, Jg. 118 (2021-09-24), Heft 38, S. 637-647 |
Veröffentlichung: | 2021 |
Medientyp: | academicJournal |
ISSN: | 1866-0452 (print) |
DOI: | 10.3238/arztebl.m2021.0254 |
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