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Analysis of Nonintervention Strategy for In-Stent
Restenosis in Pauci- or Asymptomatic Patients
He ´le `ne Eltchaninoff, MD, Raphae ¨lle Carlot, MD, Christophe Tron, MD,
Carlos Sanchez-Giron, MD, Laurent Sebagh, MD, Carla Agatiello, MD, and
Alain Cribier, MD
Between January 1996 and May 2000, we retrospec-
tively identified 66 patients (61 11 years) with
in-stent restenosis who did not undergo percutaneous
coronary intervention and/or bypass surgery and
were maintained on medical treatment alone. In-stent
restenosis was diffuse or proliferative in 86% of these
patients. At 33 11 months, 2 patients died, none
developed myocardial infarction, and 6 (9%) had
target lesion revascularization only (repeat percuta-
neous transluminal coronary angioplasty). Medical
treatment alone was associated with a good long-
term clinical follow-up in selected patients with sig-
nificant documented in-stent restenosis. 2004 by
Excerpta Medica, Inc.
(Am J Cardiol 2004;93:1038 –1040)
C
oronary stenting is the procedure of choice in most
percutaneous coronary interventions. However,
angiographic and clinical in-stent restenosis (ISR) will
develop in 15% to 45% of cases. Therefore, the man-
agement of ISR has become an important clinical
problem. Balloon angioplasty alone for the treatment
of ISR has been associated with a high recurrence rate
of restenosis,
1
reaching 85% in angiographic stud-
ies.
2,3
Several alternative percutaneous techniques
have been evaluated in this setting: repeat stenting,
4,5
rotational atherectomy,
6
laser angioplasty,
7
and use of
a cutting balloon.
8
None of these
9
has demonstrated
any advantage over plain balloon angioplasty. Intra-
coronary radiation therapy
10,11
has been evaluated and
appears promising, but its use is limited by cost and
availability. Despite very limited series and prelimi-
nary results, the use of drug-coated stents also appears
encouraging.
12–14
However, few data are available on
the long-term outcome of patients maintained on med-
ical therapy alone.
15
Thus, the goal of our study was to
evaluate the long-term outcome of patients with an-
giographically proved ISR who received medical
treatment alone without percutaneous or surgical re-
vascularization.
•••
Review of consecutive patients who underwent
cardiac catheterization at the Charles Nicolle Hospital
in Rouen, France, between January 1996 and May
From the Charles Nicolle Hospital, University of Rouen, Rouen, France.
Dr. Eltchaninoff’s address is: Ho ˆpital Charles Nicolle, 1, rue de
Germont, 76031 Rouen Cedex, France. E-mail: helene.eltchaninoff@
chu-rouen.fr. Manuscript received September 5, 2003; revised manu-
script received January 3, 2004 and accepted January 5, 2004.
1038 ©2004 by Excerpta Medica, Inc. All rights reserved. 0002-9149/04/$–see front matter
The American Journal of Cardiology Vol. 93 April 15, 2004 doi:10.1016/j.amjcard.2004.01.012