In-Stent Restenosis Best Corrected With Drug-Eluting Stent

NEW YORK (Reuters Health) Aug 21
- The risk of restenosis is significantly lower when revascularization is achieved with a paclitaxel-eluting stent than by vascular brachytherapy for a bare metal stent in-stent restenosis, according to the 2-year findings of the TAXUS V-ISR multicenter trial.
Dr. Stephen G. Ellis of the Cleveland Clinic in Ohio and colleagues prospectively randomized 396 patients with a bare metal stent restenosis to receive either a Taxus stent or vascular brachytherapy treatment.

Ischemia-driven target lesion revascularization was required less frequently with the paclitaxel-eluting stent than with vascular brachytherapy, with revascularization rates of 5.3% and 10.3% at 9 to 24 months, respectively, the investigators report in the July issue of the European Heart Journal.

At 24 months, ischemia-driven target lesion revascularization was significantly reduced with paclitaxel-eluting stent, with a rate of 10.1% compared with 21.6% for vascular brachytherapy.

There were no significant differences in death, myocardial infarction, or target vessel thrombosis between the two groups after 1 or 2 years.

In an editorial, Dr. Debabrata Mukherjee of the University of Kentucky at Lexington notes that the era of bare metal stent is waning again, while the use of drug-eluting stents is once again becoming the preferred option for in-stent restenosis.

In 2007, the use of drug-eluting stents dropped because of concerns with restenosis. "We have more objective data now to support the use of drug-eluting stents. The key is the use of aspirin and clopidogrel, with their use extended for 1 year," Dr. Mukherjee commented in an interview with Reuters Health.

"The bottom line is that at this point in time, drug-eluting stents implantation (for in-stent restenosis) is best," Dr. Mukherjee asserted. "There are some exceptions, such as diffuse stenosis of the proximal (left anterior descending artery), when bypass surgery would be a better option."

"Still, about one third of patients in the US receive a bare metal stent," Dr. Mukherjee cautioned. "That's a significant population; it's about 100,000 people."

Eur Heart J 2008;29:1595-1596,1625-1634.


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Reuters Health Information 2008. © 2008 Reuters Ltd.

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