Objective: To assess the effectiveness of routine sirolimus eluting stent (SES) implantation for unselected patients with instent restenosis and to provide preliminary information about the angiographic outcome for le...Objective: To assess the effectiveness of routine sirolimus eluting stent (SES) implantation for unselected patients with instent restenosis and to provide preliminary information about the angiographic outcome for lesion subgroups and for different in-stent restenosis patterns. Design: Prospective, single centre registry. Setting: Tertiary referral centre. Patients: 44 consecutive patients(53 lesions) without previous brachytherapy who were treated with SES for in-stent restenosis were evaluated. Routine angiographic follow up was obtained at six months and the incidence of major adverse cardiovascular events was evaluated. Results: At baseline, 42%of the lesions were focal, 21%diffuse, 26%proliferative, and 11%total occlusions. Small vessel size (reference diameter ≤2.5 mm) was present in 49%, long lesions( > 20 mm) in 30%, treatment of bypass grafts in 13%, and bifurcation stenting in 18%. At follow up, post-SES restenosis was observed in 14.6%. No restenosis was observed in focal lesions. For more complex lesions, restenosis rates ranged from 20-25%. At the one year follow up, the incidence of death was 0, myocardial infarction 4.7%(n=2), and target lesion revascularisation 16.3%(n=7). The target lesion was revascularised because of restenosis in 11.6%(n=5). Conclusions: Routine SES implantation is highly effective for focal in-stent restenosis and appears to be a promising strategy for more complex patterns of restenosis.展开更多
Objectives: To determine the long term outcome after intracoronary βradiation therapy(IRT). Setting: Tertiary referral centre. Methods: The rate of major adverse cardiac events(MACE) was retrospectively determined in...Objectives: To determine the long term outcome after intracoronary βradiation therapy(IRT). Setting: Tertiary referral centre. Methods: The rate of major adverse cardiac events(MACE) was retrospectively determined in 301 consecutive patients who were treated with IRT. MACE was defined as death, myocardial infarction, or any reintervention. Long term clinical outcome was obtained from an electronic database of hospital records and from questionnaires to the patients and referring physicians. Long term survival status was assessed by written inquiries to the municipal civil registries. Results: The mean(SD) follow up was 3.6(1.2) years. The cumulative incidence of MACE at six months was 19.1%, at one year 36.4%, and at four years 58.3%. The target lesion revascularisation(TLR) rate at six months was 12.9%, at one year 28.3%, and at four years 50.4%. From multivariate analysis, dose< 18 Gy was the most significant predictor of TLR. At four years the cumulative incidence of death was 3.8%, of myocardial infarction 13.4%, and of coronary artery bypass surgery 11.3%. Total vessel occlusion was documented in 12.3%of the patients. Conclusions: In the long term follow up of patients after IRT, there are increased adverse cardiac events beyond the first six months.展开更多
文摘Objective: To assess the effectiveness of routine sirolimus eluting stent (SES) implantation for unselected patients with instent restenosis and to provide preliminary information about the angiographic outcome for lesion subgroups and for different in-stent restenosis patterns. Design: Prospective, single centre registry. Setting: Tertiary referral centre. Patients: 44 consecutive patients(53 lesions) without previous brachytherapy who were treated with SES for in-stent restenosis were evaluated. Routine angiographic follow up was obtained at six months and the incidence of major adverse cardiovascular events was evaluated. Results: At baseline, 42%of the lesions were focal, 21%diffuse, 26%proliferative, and 11%total occlusions. Small vessel size (reference diameter ≤2.5 mm) was present in 49%, long lesions( > 20 mm) in 30%, treatment of bypass grafts in 13%, and bifurcation stenting in 18%. At follow up, post-SES restenosis was observed in 14.6%. No restenosis was observed in focal lesions. For more complex lesions, restenosis rates ranged from 20-25%. At the one year follow up, the incidence of death was 0, myocardial infarction 4.7%(n=2), and target lesion revascularisation 16.3%(n=7). The target lesion was revascularised because of restenosis in 11.6%(n=5). Conclusions: Routine SES implantation is highly effective for focal in-stent restenosis and appears to be a promising strategy for more complex patterns of restenosis.
文摘Objectives: To determine the long term outcome after intracoronary βradiation therapy(IRT). Setting: Tertiary referral centre. Methods: The rate of major adverse cardiac events(MACE) was retrospectively determined in 301 consecutive patients who were treated with IRT. MACE was defined as death, myocardial infarction, or any reintervention. Long term clinical outcome was obtained from an electronic database of hospital records and from questionnaires to the patients and referring physicians. Long term survival status was assessed by written inquiries to the municipal civil registries. Results: The mean(SD) follow up was 3.6(1.2) years. The cumulative incidence of MACE at six months was 19.1%, at one year 36.4%, and at four years 58.3%. The target lesion revascularisation(TLR) rate at six months was 12.9%, at one year 28.3%, and at four years 50.4%. From multivariate analysis, dose< 18 Gy was the most significant predictor of TLR. At four years the cumulative incidence of death was 3.8%, of myocardial infarction 13.4%, and of coronary artery bypass surgery 11.3%. Total vessel occlusion was documented in 12.3%of the patients. Conclusions: In the long term follow up of patients after IRT, there are increased adverse cardiac events beyond the first six months.
