Current Treatment Options for Bifurcation Restenosis

Assoc. Prof. Dr. Belma Yaman1
Assoc. Prof. Dr. Özge Kurmuş2
Dr. Burak Şaşırt3

1Ankara Etlik City Hospital, Department of Cardiology, Ankara, Türkiye
2Ankara Etlik City Hospital, Department of Cardiology, Ankara, Türkiye
3Ankara Etlik City Hospital, Department of Cardiology, Ankara, Türkiye

ABSTRACT

Coronary stenting has transformed revascularization strategies in many clinical environments, offering excel- lent clinical and procedural outcomes. While the short- and long-term benefits are well-established, issues like in-stent restenosis (ISR) and stent thrombosis (ST) still represent significant challenges. Although the introduction of new-generation drug-eluting stents (DES) has considerably reduced the incidence of ISR com- pared to bare-metal stents (BMS), ISR continues to affect approximately 5-10% of all percutaneous coronary interventions (PCI). Furthermore, despite advancements in intracoronary imaging, a definitive management strategy for these complications is still lacking. Stent thrombosis and in-stent restenosis are primary causes of repeat revascularization after PCI. Bifurcation lesions, which carry a higher risk for both ISR and ST, account for around 15-20% of PCI procedures. Due to their complex anatomical features and the demanding procedu- ral requirements, these lesions are more likely to lead to complications such as ISR and ST.

Keywords: Percutaneous coronary intervention; Drug-Eluting Stents; Angioplasty, balloon, coronary; Drug-eluting balloon, in-stent restenosis

Referanslar

  1. Alfonso F, Coughlan JJ, Giacoppo D, Kastrati A, Byrne RA. Management of in-stent restenosis. EuroInterven- tion. 2022 Jun 3;18(2):e103-e123. [Crossref]  [PubMed]  [PMC]
  2. Klein LW, Nathan S, Maehara A, Messenger J, Mintz GS, Ali ZA, et al. SCAI Expert Consensus Statement on Man- agement of In-Stent Restenosis and Stent Thrombosis. J Soc Cardiovasc Angiogr Interv. 2023 May 18;2(4):100971. [Crossref]  [PubMed]  [PMC]
  3. Stefanini GG, Alfonso F, Barbato E, Byrne RA, Capodanno D, Colleran R, et al. Management of myocardial revascular- isation failure: an expert consensus document of the EAPCI. EuroIntervention. 2020 Dec 4;16(11):e875-e890. [Crossref]  [PubMed]
  4. Ullrich H, Olschewski M, Münzel T, Gori T. Coronary In- Stent Restenosis: Predictors and Treatment. Dtsch Arztebl Int. 2021 Sep 24;118(38):637-644. [Link]
  5. Alfonso F, Byrne RA, Rivero F, Kastrati A. Current treatment of in-stent restenosis. J Am Coll Cardiol. 2014 Jun 24;63(24):2659-73. [Crossref]  [PubMed]
  6. Lee JY, Park DW, Kim YH, Yun SC, Kim WJ, Kang SJ, et al. Incidence, predictors, treatment, and long-term prognosis of patients with restenosis after drug-eluting stent implan- tation for unprotected left main coronary artery disease. J Am Coll Cardiol. 2011 Mar 22;57(12):1349-58. [Crossref]  [PubMed]
  7. Tu S, Zhang L, Tian Q, Hu F, Wang Y, Chen L. Five- year outcomes of double kissing mini-culotte stenting vs. mini-culotte stenting using drug-eluting stents for the treat- ment of true coronary bifurcation lesions. Front Cardio- vasc Med. 2024 Apr 9;11:1336750. [Crossref]  [PubMed]  [PMC]
  8. Zhang JJ, Ye F, Xu K, Kan J, Tao L, Santoso T, Munawar M, et al. Multicentre, randomized comparison of two-stent and provisional stenting techniques in patients with com- plex coronary bifurcation lesions: the DEFINITION II tri- al. Eur Heart J. 2020 Jul 14;41(27):2523-2536. [Crossref]  [PubMed]
  9. Giacoppo D, Mazzone PM, Capodanno D. Current Man- agement of In-Stent Restenosis. J Clin Med. 2024 Apr 19;13(8):2377. [Crossref]  [PubMed]  [PMC]
  10. Shlofmitz E, Iantorno M, Waksman R. Restenosis of Drug-Eluting Stents: A New Classification System Based on Disease Mechanism to Guide Treatment and State-of-the-Art Review. Circ Cardiovasc Interv. 2019 Aug;12(8):e007023. Epub 2019 Jul 26. Erratum in: Circ Cardiovasc Interv. 2019 Oct;12(10):e000044. [Crossref]  [PubMed]
  11. Kufner S, Joner M, Schneider S, Tölg R, Zrenner B, Repp J, Starkmann A, et al; ISAR-DESIRE 4 Investigators. Neoin- timal Modification With Scoring Balloon and Efficacy of Drug-Coated Balloon Therapy in Patients With Restenosis in Drug-Eluting Coronary Stents: A Randomized Controlled Trial. JACC Cardiovasc Interv. 2017 Jul 10;10(13):1332- 1340. [Crossref]  [PubMed]
  12. Giacoppo D, Alfonso F, Xu B, Claessen BEPM, Adriaenssens T, Jensen C, et al. Drug-Coated Balloon Angioplasty Versus Drug-Eluting Stent Implantation in Patients With Coronary Stent Restenosis. J Am Coll Cardiol. 2020 Jun 2;75(21):2664- 2678. [Crossref]  [PubMed]  [PMC]
  13. Yabushita H, Kawamoto H, Fujino Y, Tahara S, Horikoshi T, Tada M, Amano T, et al. Clinical Outcomes of Drug-Elut- ing Balloon for In-Stent Restenosis Based on the Num- ber of Metallic Layers. Circ Cardiovasc Interv. 2018 Aug;11(8):e005935. [Crossref]  [PubMed]
  14. Ho E, Denby K, Cherian S, Ciezki J, Kolar M, Wilkinson D, Wagener J, et al. Intracoronary Brachytherapy for Drug-Elut- ing Stent Restenosis: Outcomes and Clinical Correlates. J Soc Cardiovasc Angiogr Interv. 2023 Jan 2;2(1):100550. [Crossref]  [PubMed]  [PMC]
  15. Negi SI, Torguson R, Gai J, Kiramijyan S, Koifman E, Chan R, et al. Intracoronary Brachytherapy for Recur- rent Drug-Eluting Stent Failure. JACC Cardiovasc Interv. 2016 Jun 27;9(12):1259-1265. [Crossref]  [PubMed]
  16. Mangione FM, Jatene T, Badr Eslam R, Bergmark BA, Gal- lagher JR, Shah PB, Mauri L, et al. Usefulness of Intracoro- nary Brachytherapy for Patients With Resistant Drug-Eluting Stent Restenosis. Am J Cardiol. 2017 Aug 1;120(3):369-373. [Crossref]  [PubMed]
  17. Maluenda G, Ben-Dor I, Gaglia MA Jr, Wakabayashi K, Mahmoudi M, Sardi G, Laynez-Carnicero A, et al. Clinical outcomes and treatment after drug-eluting stent failure: the absence of traditional risk factors for in-stent restenosis. Circ Cardiovasc Interv. 2012 Feb 1;5(1):12-9. [Crossref]  [PubMed]
  18. Lassen JF, Albiero R, Johnson TW, Burzotta F, Lefèvre T, Iles TL, Pan M, et al. Treatment of coronary bifurcation lesions, part II: implanting two stents. The 16th expert consensus document of the European Bifurcation Club. EuroInterven- tion. 2022 Aug 19;18(6):457-470. [Crossref]  [PubMed]  [PMC]