Effectiveness And Safety Of Different Strategies In The Management Of Coronary Stent Restenosis

Objective: To investigate the safety and efficacy of drug-eluting stent(DES),drug-coated balloon(DCB)and percutaneous transluminal coronary angioplasty(PTCA)in the treatment of coronary in-stent restenosis(ISR).Methods:From October 2018 to October 2020,96 patients with in-stent restenosis who underwent coronary angiography(CAG)in Yijishan Hospital Affiliated to Wannan Medical College,Xuancheng City,Ningguo City,Dangtu County and Hexian People ’ s Hospital were retrospectively analyzed.They were treated with DES,DCB and PTCA at the site of coronary restenosis,including 65 males(72.2%)and 25 females(27.8%),aged 40-85(64.53±9.19)years.According to the imaging results and the strategies for specific treatment of ISR lesions during PCI,the patients were divided into drug-eluting stent group(n=54),drug-coated balloon group(n=29)and balloon dilatation group(n=13).The clinical baseline data,coronary angiography data and intraoperative related data of the three groups were analyzed to explore the influencing factors of ISR lesions;At the same time,the patients were followed up for 6-12 months.The endpoints included target lesion revascularization(TLR),major adverse cardiac events(MACE),stent thrombosis(ST)and chest pain recurrence.Results: A total of 96 patients with ISR lesions were included in this study,including 65males(72.2%),71 patients with hypertension(73.9%),20 patients with diabetes(20,8%),and 58 patients with smoking history(60.4%).A total of 46(47.9%)cases of bifurcation lesions involved in PCI treatment of in De novo lesions were treated with single stent and double stent strategies,and there were differences in DES group,DCB group and BA group,with statistical significance(P<0.05).Treatment of ISR lesions using DES/DCB/BA average length(20.59±6.67vs24.83±5.73vs16.33±5.66),using DES/DCB/BA average release pressure(11.63±2.57vs10.24±2.31vs15.08±3.33),there were significant differences,with statistical significance(P<0.05).Among 96 patients with ISR,17(17.7%)patients used IVUS to clarify the mechanism of restenosis and guide the treatment strategy.Among them,2(2.1%)patients had incomplete stent expansion,5(5.2%)patients had intimal hyperplasia and atherosclerosis,6(6.3%)patients had mixed factors of stent and intimal hyperplasia,and 4(4.2%)patients had CTO lesions.There were significant differences among DES group,DCB group and BA group(P<0.05).A total of 12(12.5 %)cases were followed up;There was no significant difference in TLR,chest pain recurrence and MACE events among DES,DCB and BA groups,and there was no statistical significance(P<0.05).Statistical analysis was performed on the immediate lumen diameter and the review reference lumen diameter of the three groups.There was no significant difference in the immediate lumen diameter(P=0.225),the review reference lumen diameter(P=0.061)and the late lumen loss(P=0.240)after operation,and there was no statistical significance.Subsequently,the comparison of the LSD multiplicity of the reference lumen diameter showed that there was no significant difference between DES and DCB groups(P=0.236),and there was no significant difference between DES and BA groups(P=0.058),which was not statistically significant.There was a significant difference between DCB and BA groups(P=0.024),with statistical significance.Conclusion: This study shows that DES and DCB have better safety and effectiveness in the treatment of ISR lesions,among which DCB has more advantages and potential for treatment,while PTCA is still effective in the treatment of partial focal and mechanical ISR lesions under the premise of full pre-expansion.