Treatment of Long, Diffuse In-Stent Restenosis With Sirolimus
Treatment of long, diffuse in-stent restenosis remains a therapeutic challenge. We report the successful use of multiple sirolimus-eluting stents (three 33-mm long stents) in a long, diffuse in-stent restenotic lesion. No major adverse cardiovascular events, including acute/subacute/delayed stent thrombosis, were noted at ten months. Angiography at six months showed widely patent stents with 19% restenosis only at the worst segment.
In-stent restenosis (ISR) remains the Achilles' heel of coronary angioplasty. Brachytherapy has proven effective in the treatment of ISR, when compared with simple angioplasty. However, it may not be feasible in very long lesions or in vessels smaller than 2.75 mm. Drug-eluting stents (DES), apart from de novo lesions, have also been used to treat ISR. However, lesions treated in the study protocols were usually limited to short lesions and there are few data on the feasibility of using multiple DESs in the treatment of long, diffuse ISR. We report a case of the successful treatment of long, diffuse ISR with the use of multiple sirolimus-eluting stents.
Treatment of long, diffuse in-stent restenosis remains a therapeutic challenge. We report the successful use of multiple sirolimus-eluting stents (three 33-mm long stents) in a long, diffuse in-stent restenotic lesion. No major adverse cardiovascular events, including acute/subacute/delayed stent thrombosis, were noted at ten months. Angiography at six months showed widely patent stents with 19% restenosis only at the worst segment.
In-stent restenosis (ISR) remains the Achilles' heel of coronary angioplasty. Brachytherapy has proven effective in the treatment of ISR, when compared with simple angioplasty. However, it may not be feasible in very long lesions or in vessels smaller than 2.75 mm. Drug-eluting stents (DES), apart from de novo lesions, have also been used to treat ISR. However, lesions treated in the study protocols were usually limited to short lesions and there are few data on the feasibility of using multiple DESs in the treatment of long, diffuse ISR. We report a case of the successful treatment of long, diffuse ISR with the use of multiple sirolimus-eluting stents.