Long-term clinical follow-up after successful repeat percutaneous intervention for stent restenosis

Objectives. This study evaluated the long-term clinical outcome of successful repeat percutaneous intervention after in-stent restenosis. Background. Recurrence of symptoms and angiographic restenosis after stent implantation are observed in 15% to 35% of cases. Repeat percutaneous treatment for in-stent restenosis has been shown to be safe, with high immediate success, but little is known about the long-term clinical outcome. Methods. Clinical follow-up (minimum 9 months) was obtained in a consecutive series of 124 patients (127 vessels) presenting with stent restenosis who were successfully treated with repeat percutaneous intervention. Results. Clinical follow-up was obtained in all 124 patients at a mean [±SD] of 27.4 ± 14.7 months (range 9 to 66); a stress test was available in 88 patients (71%). Recurrence of clinical events occurred in 25 patients (20%) and included death from any cause in 2 patients (2%), target vessel revascularization in 14 (11%), myocardial infarction in 1 (1%) and positive stress test results or recurrence of symptoms (Canadian Cardiovascular Society class I to IV) treated medically in 8 (6%). Cumulative event-free survival at 12 and 24 months was 86.2% and 80.7%, respectively. Significant predictive factors of recurrence of clinical events were repeat intervention in saphenous vein grafts, multivessel disease, low ejection fraction and a ≤3-month interval between stent implantation and repeat intervention. Conclusions. In-stent balloon angioplasty for stent restenosis in native vessels seems to be an effective method in terms of a low long-term clinical event rate.