Reestenose de stents coronarianos: resultados imediatos e tardios do tratamento com excimer laser / In-stent restenosis: acute and long-term outcomes after excimer laser coronary angioplasty

ABSTRACT

Objective - With the increased use of intracoronary stents, in-stent restenosis has become a clinically significant drawback in invasive cardiology. We retrospectively assessed the short-and long-term outcomes after excimer laser coronary angioplasty of in-stent restenosis. Methods - Twenty-five patients with 33 incidents of in-stent restenosis treated with excimer laser coronary angioplasty (ELCA) were analyzed. Sixty-six percent were males, mean age of 73+ 11 years, and 83 per cent were functional class III-IV (NYHA). ELCA was performed using 23 concentric and 10 eccentric catheters with a diameter of 1.6-2.2 mm, followed by balloon angioplasty (PTCA) and untrasound monitoring. The procedure was performed in the following vessels left anterior descending artery, 10; left circunflex artery, 8; right coronary artery, 6; left main coronary artery; 2 and venous bypass graft, 7. Results - The ELCA was successful in 71 per cent of the cases, and PTCA was 100 per cent successful. The diameter of the treated vessels was 3.44+0.5 mm; the minimal luminal diameter (MLD) increased from 0.30mm pre-ELCA to 1,97mm post-ELCA, and to 2.94mm post-PTA (p<0.001). The percent stenosis was reduced from 91.4+9.5 per cent before ELCA to 42.3+14.9 per cent after ELCA and to 14.6+9.3 per cent after PTCA (P<0.001). Seventeen (68 per cent) patients were asymptomatic at 6 months and 15 (60 per cent) at 1 year. New restenosis rates were 8/33 (24.2 per cent) at 6 months and 9/33 (27.3 per cent) at 12 months. Conclusion - ELCA is safe effective for the treatment of in-stent restenosis. In the present sample, a slight increase in new restenotic lesions between 6 and 12 months was found.