Device Therapytreating Restenosis After Drug-Eluting Stent Implantation

RESEARCH HIGHLIGHTS Nature Reviews Cardiology 10, 62 (2013); published online 18 December 2012; doi:10.1038/nrcardio.2012.189

DEVICE THERAPY Treating restenosis after drug-eluting stent implantation

Drug-eluting stents (DES), including stents is intuitively attractive,” says Robert Byrne, In their study report, the researchers eluting sirolimus or one of its analogues lead author on the study report. highlight that trials involving longer (limus-eluting stents), are a common The investigators enrolled 402 patients follow-up in larger groups of patients are choice of treatment for patients with with restenosis after implantation of a needed to confirm the safety of using PEB coronary artery disease. Although these limus-eluting stent and randomly assigned in this setting and to determine whether any stents are superior to bare-metal stents, them to receive a PES (n = 131), PEB differences in the effects of PEB and PES are some patients with DES will eventually (n = 137), or balloon angioplasty with no clinically meaningful. They also point out have restenosis. Repeat stenting is an option drug elution (n = 134). Paclitaxel was used that their findings might not be applicable for these patients, but some clinicians are in both drug-eluting devices to restrict to other drug-eluting balloon catheters. concerned about the potential effects of differences to the device itself. PES and The researchers have already begun the several stent layers in the vessel wall. The PEB were superior to angioplasty with a ISAR-DESIRE 4 study, which will examine ISAR-DESIRE 3 study investigators have noneluting balloon, as measured by the whether the efficacy of PEB treatment now shown that paclitaxel-eluting balloons diameter of stenosis 6–8 months after could be improved by first preparing the (PEB) are not inferior to paclitaxel-eluting treatment (37.4%, 38.0%, and 54.1% lesion with cutting or scoring balloon stents (PES) for the treatment respectively). PEB was noninferior to PES. dilation. “Among other benefits, such of patients with restenosis. Target lesion revascularization 1 year an approach might improve tissue drug NPG “The prospect of achieving after the procedure occurred less frequently distribution,” says Byrne. high antirestenotic efficacy in patients treated with PES or PEB than in without requirement for patients who had angioplasty with a Megan Cully additional stent implantation noneluting balloon (13.5%, 22.1%, and 43.5% respectively). The differences Original article Byrne, R. A. et al. Paclitaxel-eluting between PES and PEB were not statistically balloons, paclitaxel-eluting stents, and balloon angioplasty significant. All groups had comparable rates in patients with restenosis after implantation of a drug- of death, myocardial infarction and target eluting stent (ISAR-DESIRE 3): a randomised, open-label trial. Lancet doi:10.1016/S0140-6736(12)61964-3 lesion thrombosis.