Dear Dr. Najm,
We are grateful to Dr. Violeta Dinesch for his interest in our article on drug eluting stent (DES)-associated restenosis, and for his valuable comments.
Actually, the retrospective nature of our study is a clear limitation which precludes tracking and analysis of relevant data as that raised by Dr. Dinesch. As we have mentioned in our study methods [1], the decision of treatment between balloon angioplasty (BA) and implantation of another DES was left to the operator’s discretion. According to our study, the operators preferred repeated DES strategy with bifurcation lesions and chronic total occlusions, and IVUS-guidance was more frequently utilized. However, this was not the case with DES re-restenosis patients. The small number of this patient group (39 patients) precludes drawing consistent criteria upon which the operators would have probably built their treatment decision.
Kokura memorial hospital, where the study has been conducted, follows rigorously standardized protocols for percutaneous coronary interventions (PCI). Our study was conducted between 2006–2008, during which the DES utilized in the hospital were of the first generation (Cypher and Taxus). According to the institutional protocols, and as previously noted in our study methods, a switch strategy (Hetero-DES) was adopted in all cases, including those with DES re-restenosis. Nevertheless, whether or not to adopt a switch strategy in DES-associated restenosis is still a matter of debate [2], [3], even with second-generation DES [4].
Basically, our study throws a stone in stagnant water, by reporting long-term clinical and angiographic follow-up findings among patients with DES-associated restenosis and re-restenosis, exploring different treatment modalities. Further, prospective sufficiently powered studies should further unravel the conflict associated with such disease entity, in the absence of clear consensus as to which treatment modality is by far the best.
Footnotes
Peer review under responsibility of King Saud University
References
- 1.Abdelmegid M.A.F., Ahmed T.A.N., Kato M., Ando K., Domei T., Iwabuchi M. Drug-eluting stents or balloon angioplasty for drug-eluting stent-associated restenosis: an observational follow-up study of first-time versus repeated restenosis. J Saudi Heart Assoc. 2016 doi: 10.1016/j.jsha.2016.10.001. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 2.Alfonso F., Perez-Vizcayno M.J., Dutary J., Zueco J., Cequier A., Garcia-Touchard A. Implantation of a drug-eluting stent with a different drug (switch strategy) in patients with drug-eluting stent restenosis. Results from a prospective multicenter study (RIBS III [Restenosis Intra-Stent: Balloon Angioplasty Versus Drug-Eluting Stent]) JACC Cardiovasc Interv. 2012;5(7):728–737. doi: 10.1016/j.jcin.2012.03.017. [DOI] [PubMed] [Google Scholar]
- 3.Nojima Y., Yasuoka Y., Kume K., Adachi H., Hattori S., Matsutera R. Switching types of drug-eluting stents does not prevent repeated in-stent restenosis in patients with coronary drug-eluting stent restenosis. Coron Artery Dis. 2014 Dec;25(8):638–644. doi: 10.1097/MCA.0000000000000159. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 4.Ota H., Mahmoudi M., Kitabata H., Torguson R., Chen F., Satler L.F. Safety and efficacy of limus-eluting stents and balloon angioplasty for sirolimus-eluting in-stent restenosis. Cardiovasc Revasc Med. 2015;16(2):84–89. doi: 10.1016/j.carrev.2015.01.004. [DOI] [PubMed] [Google Scholar]