Balloon angioplasty for the treatment of coronary in-stent restenosis: Immediate results and 6-month angiographic recurrent restenosis rate

Objectives. The purpose of this prospective study was to evaluate the immediate results and the 6-month angiographic recurrent restenosis rate after balloon angioplasty for in stent restenosis. Background. Despite excellent immediate and mid-term results, 20% to 30% of patients with coronary stent implantation will present an angiographic restenosis and may require additional treatment. The optimal treatment for in-stent restenosis is still unclear. Methods. Quantitative coronary angiography (QCA) analyses were performed before and after stent implantation, before and after balloon angioplasty for in stent restenosis and on a 6-month systematic coronary angiogram to assess the recurrent angiographic restenosis rate. Results. Balloon angioplasty was performed in 52 patients presenting in-stent restenosis. In-stent restenosis was either diffuse (greater than or equal to 10 mm) inside the stent (71%) or focal (29%). Mean stent length was 16 +/- 7 mm. Balloon diameter of 2.98 +/- 0.37 mm and maximal inflation pressure of 10 +/- 3 atm were used for balloon angioplasty. Angiographic success rate was 100% without any complication. Acute gain was lower after balloon angioplasty for in stent restenosis than after stent implantation: 1.19 +/- 0.60 mm VS. 1.75 +/- 0.68 mm (p = 0.0002). At 6-month follow up, 60% of patients were asymptomatic and no patient died. Eighteen patients (35%) had repeat target vessel revascularization, Angio graphic restenosis rate was 54%. Recurrent restenosis rate was higher when in-stent restenosis was diffuse: 63% vs. 31% when focal, p = 0.046. Conclusions. Although balloon angioplasty for in stent restenosis can be safely and successfully performed, it leads to less immediate stenosis improvement than at time of stent implantation and carries a high recurrent angiographic restenosis rate at 6 months, in particular in diffuse in-stent restenosis lesions. (C) 1998 by the American College of Cardiology.